Reward-Related Attentional Bias at Age 16 Predicts Onset of Depression During 9 Years of Follow-up

Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study

BACKGROUND

Despite COVID-19 vaccine mandates, many chose to forgo vaccination, raising questions about the psychology underlying how judgment affects these choices. Research shows that reward and aversion judgments are important for vaccination choice; however, no studies have integrated such cognitive science with machine learning to predict COVID-19 vaccine uptake.

OBJECTIVE

This study aims to determine the predictive power of a small but interpretable set of judgment variables using 3 machine learning algorithms to predict COVID-19 vaccine uptake and interpret what profile of judgment variables was important for prediction.

METHODS

We surveyed 3476 adults across the United States in December 2021. Participants answered demographic, COVID-19 vaccine uptake (ie, whether participants were fully vaccinated), and COVID-19 precaution questions. Participants also completed a picture-rating task using images from the International Affective Picture System. Images were rated on a Likert-type scale to calibrate the degree of liking and disliking. Ratings were computationally modeled using relative preference theory to produce a set of graphs for each participant (minimum R2>0.8). In total, 15 judgment features were extracted from these graphs, 2 being analogous to risk and loss aversion from behavioral economics. These judgment variables, along with demographics, were compared between those who were fully vaccinated and those who were not. In total, 3 machine learning approaches (random forest, balanced random forest [BRF], and logistic regression) were used to test how well judgment, demographic, and COVID-19 precaution variables predicted vaccine uptake. Mediation and moderation were implemented to assess statistical mechanisms underlying successful prediction.

RESULTS

Age, income, marital status, employment status, ethnicity, educational level, and sex differed by vaccine uptake (Wilcoxon rank sum and chi-square P<.001). Most judgment variables also differed by vaccine uptake (Wilcoxon rank sum P<.05). A similar area under the receiver operating characteristic curve (AUROC) was achieved by the 3 machine learning frameworks, although random forest and logistic regression produced specificities between 30% and 38% (vs 74.2% for BRF), indicating a lower performance in predicting unvaccinated participants. BRF achieved high precision (87.8%) and AUROC (79%) with moderate to high accuracy (70.8%) and balanced recall (69.6%) and specificity (74.2%). It should be noted that, for BRF, the negative predictive value was <50% despite good specificity. For BRF and random forest, 63% to 75% of the feature importance came from the 15 judgment variables. Furthermore, age, income, and educational level mediated relationships between judgment variables and vaccine uptake.

CONCLUSIONS

The findings demonstrate the underlying importance of judgment variables for vaccine choice and uptake, suggesting that vaccine education and messaging might target varying judgment profiles to improve uptake. These methods could also be used to aid vaccine rollouts and health care preparedness by providing location-specific details (eg, identifying areas that may experience low vaccination and high hospitalization).

Patterns of attentional biases in children and emotional symptoms during the COVID-19 pandemic: a two-wave longitudinal study

BACKGROUND

It is unknown how the patterns of negative and positive attentional biases in children predict fear of COVID-19, anxiety symptoms, and depression symptoms during the COVID-19 pandemic. The study identified profiles of negative and positive attentional biases in children and examined their association with emotional symptoms during the COVID-19 pandemic.

METHOD

264 children (girls: 53.8% and boys: 46.2%) of 9-10 years born in Hong Kong or mainland China from a primary school in Shenzhen, People's Republic of China were involved in a two-wave longitudinal study. Children completed the COVID-19 Fear Scale, the Revised Child Anxiety and Depression Scale, and the Attention to Positive and Negative Information Scale to measure fear of COVID-19, anxiety and depression symptoms, and negative and positive attentional biases in classrooms. After six months, they completed the second assessment of fear of COVID-19, anxiety symptoms, and depression symptoms in classrooms. Latent profile analysis was conducted to reveal distinct profiles of attentional biases in children. A series of repeated MANOVA was performed to examine the association of profiles of attentional biases to fear of COVID-19, anxiety symptoms, and depression symptoms across 6 months.

RESULTS

Three profiles of negative and positive attentional biases were revealed in children. Children with a "moderate positive and high negative attentional biases" profile had significantly higher fear of the COVID-19 pandemic, anxiety symptoms, and depression symptoms than children with a "high positive and moderate negative attentional biases" profile. Children with a "low positive and negative attentional biases" profile were not significantly different in fear of COVID-19, anxiety symptoms, and depression symptoms than those with the other two profiles.

CONCLUSIONS

Patterns of negative and positive attentional biases were related to emotional symptoms during the COVID-19 pandemic. It might be important to consider children's overall patterns of negative and positive attentional biases to identify children at risk of higher emotional symptoms.

Association between adolescent oral contraceptive use and future major depressive disorder: a prospective cohort study

BACKGROUND

Because of the widespread use of oral contraceptives (OCs) and the devastating effects of depression both on an individual and a societal level, it is crucial to understand the nature of the previously reported relationship between OC use and depression risk. Insight into the impact of analytical choices on the association is important when interpreting available evidence. Hence, we examined the association between adolescent OC use and subsequent depression risk in early adulthood analyzing all theoretically justifiable models.

METHODS

Data from the prospective cohort study TRacking Adolescents' Individual Lives Survey, among women aged 13-25 years were used. Adolescent OC use (ages 16-19 years) was used as a predictor and major depressive disorder (MDD) in early adulthood (ages 20-25 years), as assessed by the Diagnostic and Statistical Manual of Mental Disorders-IV oriented Lifetime Depression Assessment Self-Report and the Composite International Diagnostic Interview, was used as an outcome. A total of 818 analytical models were analyzed using Specification Curve Analysis in 534 adolescent OC users and 191 nonusers.

RESULTS

Overall, there was an association of adolescent OC use and an episode of MDD in early adulthood [median odds ratio (OR)_median  = 1.41; OR_min  = 1.08; OR_max  = 2.18, p < .001], which was driven by the group of young women with no history of MDD (OR_median  = 1.72; OR_min  = 1.21; OR_max  = 2.18, p < .001).

CONCLUSIONS

In summary, adolescent OC use was associated with a small but robust increased risk for experiencing an episode of MDD, especially among women with no history of MDD in adolescence. Understanding the potential side effects of OCs will help women and their doctors to make informed choices when deciding among possible methods of birth control.

Hypersensitivity to negative feedback during dynamic risky-decision making in major depressive disorder: An event-related potential study

BACKGROUND

Patients with major depressive disorder (MDD) exhibit a diminished ability to think or concentrate, indecisiveness, and altered sensitivity to reward and punishment. These impairments can influence complex risk-related decision-making in dynamic environments. The neurophysiological mechanisms mediating MDD effects on decision-making behavior are not well understood.

METHODS

Patients with MDD (N=50) and healthy controls (HC, N=40) were enrolled. They completed a series of psychometric tests. Event-related potentials (ERPs) were recorded during the performance of a well-validated modified version of Balloon Analogue Risk Task (BART).

RESULTS

BART behavior data were similar across the two groups except the MDD patients showed more stability of risk aversion. Neurophysiologically, BART losses generated larger P3 amplitudes than wins, and MDD patients had larger feedback-related negativity (FRN) components than HCs in response to negative feedback (losses). Greater FRN amplitudes in response to losses correlated with higher levels of depressiveness, psychological pain, and anhedonia. A longer FRN latency in MDD patients was associated with more severe suicidal ideation.

LIMITATIONS

The findings are based on cross-sectional data, which are not powerful enough to make causal inferences.

CONCLUSION

MDD patients exhibit enhanced FRNs in the frontocentral region after receiving negative feedback in a risky decision-making task. FRN magnitude is associated with depressive symptom severity. Punishment hypersensitivity may contribute to the maintenance of depressive symptoms in MDD patients, and FRN may be a useful index of such hypersensitivity.

Reward Responsiveness, Optimism, and Social and Mental Functioning in Children Aged 6-7: Protocol of a Cross-Sectional Pilot Study

Background

There is evidence that reward responsiveness and optimism are associated with mental and social functioning in adolescence and adulthood, but it is unknown if this is also the case for young children. Part of the reason for this gap in the literature is that the instruments that are used to assess reward responsiveness and optimism in adolescents and adults are usually not suitable for young children.

Objective

Two behavioral tasks to assess reward learning, a questionnaire on reward responsiveness, and a questionnaire on optimism/pessimism will be tested on their feasibility and reliability in children aged 6-7. Depending on their feasibility and reliability, these instruments will also be used to investigate if reward responsiveness and optimism are associated with mental and social functioning in young children.

Methods

For this cross-sectional pilot study, we adapted a number of tasks and questionnaires to the needs of 6-7-year-old children, by simplification of items, oral rather than written assessment, and reducing the number of conditions and items. We will approach teachers and, with their help, aim to include 70 children aged 6-7 to assess the feasibility and reliability of the tasks and questionnaires. Feasibility measures that will be reported are the proportion of children completing the task/questionnaire, the proportion of children that were able to explain the instructions in their own words to the researcher, and the proportion of children that correctly answered the control questions. The reliability of the scales will be assessed by computing Cronbach α and item-total score correlations and the reliability of the tasks by correlations between different consecutive blocks of trials. Ethics approval was obtained from the Ethics Committee of the Department of Pedagogy and Educational Sciences.

Results

Data collection was originally planned in March and April 2020, but has been postponed due to Corona virus regulations. We expect to collect the data in the first half of 2021. The findings will be disseminated in preprints and peer-reviewed publications.

Conclusions

The development of feasible and reliable instruments for assessing reward responsiveness and optimism in young children is expected to benefit future research on underlying mechanisms of mental and social functioning in young children. If the instruments assessed in this study are usable with young children, it would be particularly interesting to include them in cohort studies because this would enable investigating not only concurrent associations, but also prospective associations between reward responsiveness and optimism early in life and mental and social functioning later in life. If, as we hypothesize, reward responsiveness and optimism are not only associated with (prospective) mental and social functioning in adults and adolescents but also in young children, this could provide a way of identifying vulnerable children already at an early stage.

International Registered Report Identifier (IRRID)

PRR1-10.2196/18902

Attentional Bias for Cues Signaling Punishment and Reward in Adolescents: Cross-Sectional and Prognostic Associations with Symptoms of Anxiety and Behavioral Disorders

Heightened reward sensitivity has been proposed as a risk factor for developing behavioral disorders whereas heightened punishment sensitivity has been related to the development of anxiety disorders in youth. Combining a cross-sectional (n = 696, mean age = 16.14) and prospective (n = 598, mean age = 20.20) approach, this study tested the hypotheses that an attentional bias for punishing cues is involved in the development of anxiety disorders and an attentional bias for rewarding cues in the development of behavioral disorders. A spatial orientation task was used to examine the relation between an attentional bias for punishing cues and an attentional bias for rewarding cues with anxiety and behavioral problems in a subsample of a large prospective population cohort study. Our study indicates that attentional biases to general cues of punishment and reward do not seem to be important risk factors for the development of anxiety or behavioral problems respectively. It might be that attentional biases play a role in the maintenance of psychological problems. This remains open for future research.

Editorial: Missing the Pull of Life's Rewards? Attention Shifting and the Development of Depression

A burgeoning literature is elucidating the nature of reward disruption in the development of depression. At this point, the question is not whether reward function is disrupted, but how.¹ Early conceptual models of the disorder emphasized that depression involves disturbances to positive affect-not just negative affect-but clinical affective science took some time to catch up. Currently, investigations of reward processing, a component and mechanism of positive affect, are prominent in depression research. Developmental research on this topic has proceeded from early studies establishing that reward function is altered in adolescent depression to investigations attempting to disentangle the ways in which reward processing is disrupted before, during, and after the onset of depression. Attentional flexibility in the context of reward and punishment provides an intriguing potential context for altered reward processing in vulnerable youth.