1
|
Riehle M, Straková A, Lincoln TM. Emotional Experience of People With Schizophrenia and People at Risk for Psychosis: A Meta-Analysis. JAMA Psychiatry 2024; 81:57-66. [PMID: 37755868 PMCID: PMC10535019 DOI: 10.1001/jamapsychiatry.2023.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 09/28/2023]
Abstract
Importance Psychotic symptoms are associated with subjective reports of aberrant emotion, such as excessive fear or anhedonia, but whether these aberrations reflect aberrant emotional experience of normative stimuli is uncertain both for individuals with schizophrenia and those at risk for psychosis. Objective To provide a meta-analysis of study samples of emotional experience in individuals with schizophrenia and those at risk for psychosis as assessed in laboratory-based emotion-induction studies. Data Sources MEDLINE and PsycINFO databases were searched for articles published from January 1986 and Google Scholar citations of a relevant earlier meta-analysis until August 2022. Reference lists were manually searched for additional studies. Study Selection Included studies measured positive or negative emotional experience in response to standardized emotionally evocative stimuli and compared participants diagnosed with schizophrenia or participants at risk for psychosis with healthy controls. Data Extraction and Synthesis The meta-analysis was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by 2 independent coders, and random-effects analyses were conducted. Main Outcomes and Measures Outcomes were 3 scales of emotional experience (unipolar positive emotion, unipolar negative emotion, bipolar valence), analyzed separately for pleasant, neutral, and unpleasant stimuli. A meta-analysis was conducted for differences between the 2 clinical groups combined and controls. Subgroup differences (schizophrenia vs at risk) and the influence of several other variables were tested in moderator analyses. Results This systematic review and meta-analysis included data from 111 studies and 6913 participants (schizophrenia: 2848 [41.2%]; at risk: 877 [12.7%]; healthy controls: 3188 [46.1%]). Compared with controls, people with schizophrenia and those at risk for psychosis experienced pleasant stimuli as less positive (unipolar positive: standardized mean difference [SMD] Hedges g = -0.19; P =.001; bipolar valence: SMD Hedges g = -0.28; P <.001) and more negative (Hedges g = 0.52; P <.001), neutral stimuli as more negative (Hedges g = 0.55; P <.001), and unpleasant stimuli as both more positive (unipolar positive: SMD Hedges g = 0.23; P =.005; bipolar valence: Hedges g = 0.12; P =.01) and more negative (Hedges g = 0.22; P <.001). Moderator analyses indicated a less aberrant emotional experience for odors than for visual stimuli (unipolar negative, pleasant z score = -2.97; P =.003; unipolar negative, neutral z score = -2.70; P =.007), an association between higher negative symptoms and diminished positive emotion for pleasant stimuli in schizophrenia (z score = -2.98; P =.003), and that subgroup differences were limited to neutral stimuli. Conclusions and Relevance Results suggest a pattern of aberrant emotional experience of normative stimuli in schizophrenia and that this already was observable before disorder onset. In particular, the aberrant experience of pleasant stimuli needs to be considered as an intervention target.
Collapse
Affiliation(s)
- Marcel Riehle
- Institute for Psychology, Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Alexandra Straková
- Department of Psychology, Comenius University in Bratislava, Bratislava, Slovakia
| | - Tania M. Lincoln
- Institute for Psychology, Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| |
Collapse
|
2
|
Chang CY, Tsai MN, Sung YT, Cho SL, Chen HC. Weighting Assessment of the Effect of Chinese State-Changing Words on Emotions. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2023; 52:2545-2566. [PMID: 37688761 DOI: 10.1007/s10936-023-09986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 09/11/2023]
Abstract
Past studies of sentiment analysis have mainly applied algorithms based on vocabulary categories and emotional characteristics to detect the emotionality of text. However, the collocation of state-changing words and emotional vocabulary affects emotions. For example, adverbs of degree strengthen emotions, and negative adverbs reverse emotions. This study investigated the weighted effect of state-changing words on emotion. The research material comprised 73 state-changing words that were collocated with four emotions: happiness, sadness, fear, and anger. A total of 84 participants participated in the vocabulary assessment. The results revealed that state-changing words could be classified into four types: intensifying, weakening, neutralizing, and reversing. In a comparison of the weighting factors among emotions, the weighting effect of the same state-changing word in the positive emotion category was particularly evident. The results could serve as a reference for follow-up studies on detecting emotions in text.
Collapse
Affiliation(s)
- Chia-Yueh Chang
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Education College Building, Room 612, No. 162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 10610, Taiwan, ROC
| | - Meng-Ning Tsai
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Education College Building, Room 612, No. 162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 10610, Taiwan, ROC
| | - Yao-Ting Sung
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Education College Building, Room 612, No. 162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 10610, Taiwan, ROC
- Chinese Language and Technology Center, National Taiwan Normal University, Taipei, Taiwan, ROC
- Institute for Research Excellence in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan, ROC
- Department of Computer Science and Information Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
- Graduate Institute of Information and Computer Education, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Shu-Ling Cho
- Department of Clinical Psychology, Fu-Jen Catholic University, Taipei, Taiwan, ROC
| | - Hsueh-Chih Chen
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Education College Building, Room 612, No. 162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 10610, Taiwan, ROC.
- Chinese Language and Technology Center, National Taiwan Normal University, Taipei, Taiwan, ROC.
- Institute for Research Excellence in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan, ROC.
- NSTC AI Biomedical Research Center, Taipei, Taiwan, ROC.
| |
Collapse
|
3
|
Gupta T, Horton WS, Haase CM, Carol EE, Mittal VA. Clues from caregiver emotional language usage highlight the link between putative social environment and the psychosis-risk syndrome. Schizophr Res 2023; 259:4-10. [PMID: 35400558 PMCID: PMC9578001 DOI: 10.1016/j.schres.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Familial emotional word usage has long been implicated in symptom progression in schizophrenia. However, few studies have examined caregiver emotional word usage prior to the onset of psychosis, among those with a clinical high-risk (CHR) syndrome. The current study examined emotional word usage in a sample of caregivers of CHR individuals (N = 37) and caregivers of healthy controls (N = 40) and links with clinical symptoms in CHR individuals. Caregivers completed a speech sample task in which they were asked to speak about the participant; speech samples were then transcribed and analyzed for general positive (e.g. good) and negative (e.g., worthless) emotional words as well as words expressing three specific negative emotions (i.e., anxiety, anger, and sadness) using Linguistic Inquiry and Word Count (LIWC). Findings indicated that (1) CHR caregivers used more negative and anxiety words compared to control caregivers; and (2) less positive word usage among CHR caregivers were related to more positive symptomatology among CHR individuals. These findings point toward the utility of automated language analysis in assessing the intersections between caregiver emotional language use and psychopathology.
Collapse
Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA.
| | - William S Horton
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Claudia M Haase
- Department of Psychology, Northwestern University, Evanston, IL, USA; School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Emily E Carol
- Psychotic Disorders Division, McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| |
Collapse
|
4
|
Ryan C, Cogan S. Eliciting Expressions of Emotion: An Exploratory Analysis of Alexithymia in Adults with Autism Utilising the APRQ. J Autism Dev Disord 2022; 53:2499-2513. [PMID: 35394243 DOI: 10.1007/s10803-022-05508-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
This study examined alternative methods for detecting alexithymia to the Toronto Alexithymia Scale-20 (TAS-20) by comparing the emotional linguistic performance of ASD and NT samples (n = 32 in each) on the Alexithymia Provoked Responses Questionnaire (APRQ). We utilised both the LIWC and tidytext approaches to linguistic analysis. The results indicate the ASD sample used significantly fewer affective words in response to emotionally stimulating scenarios and had less emotional granularity. Affective word use was correlated with ASD symptomatology but not with TAS-20 scores, suggesting that some elements of alexithymia are not well detected by the TAS-20 alone. The APRQ, in combination with the tidytext package, offers significant potential for sophisticated exploration of emotional expression in ASD.
Collapse
Affiliation(s)
- Christian Ryan
- School of Applied Psychology, University College Cork, Distillery House, North Mall, Cork, T23 TK30, Ireland.
| | - Stephen Cogan
- Aspect, Cork Association for Autism, Carrigtwohill, Cork, Ireland
| |
Collapse
|
5
|
Lai J, Snyder ME, Vijayakumar KSM, Bailey DH, Martin EA. Shared and unique affective abnormalities in schizotypy dimensions. Psych J 2022; 11:149-162. [PMID: 35001544 DOI: 10.1002/pchj.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022]
Abstract
Attention to affect is theoretically a precursor to one's ideal affect (i.e., preference for feeling low- and high-arousal positive and negative affect) and emotion regulation (ER). In schizotypy, there have been mixed findings regarding abnormalities in attention to affect. At the same time, little is known about ideal affect in schizotypy or whether differences in ideal affect or ER difficulties in schizotypy are driven by attention to affect. Thus, this study aimed to identify shared and unique abnormalities in attention to affect, ideal affect, and ER difficulties in schizotypy, and to test whether attention to affect underlies differences in ideal affect and ER difficulties. Using groups of individuals with either extreme levels of social anhedonia (SocAnh; n = 181), extreme levels of perceptual aberrations/magical ideation (PerMag; n = 105), or individuals low on both (i.e., controls; n = 531), we tested group differences in attention to affect, ideal affect, and ER difficulties. Our findings suggest both shared and unique affective abnormalities; compared to controls, the SocAnh group paid the least attention to positive affect. Only PerMag had heightened attention to negative affect compared to controls. Additionally, we found unique abnormalities relating to ideal affect but mostly shared difficulties in ER in schizotypy. Abnormalities in ideal affect and ER remain largely consistent after accounting for attention to affect for PerMag, suggesting that attention to affect is not the primary mechanism driving these abnormalities. However, we found evidence that attention to affect underlies some SocAnh-control group differences in ideal affect and ER difficulties. Our work helps to clarify prior work and contributes to the understanding of shared and unique affective abnormalities in schizotypy. Future research may consider longitudinal approaches to test causal mechanisms of affective abnormalities in schizotypy.
Collapse
Affiliation(s)
- Jocelyn Lai
- Department of Psychological Science, University of California, Irvine, California, USA
| | - Madeline E Snyder
- Department of Psychological Science, University of California, Irvine, California, USA
| | | | - Drew H Bailey
- School of Education, University of California, Irvine, California, USA
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, California, USA
| |
Collapse
|
6
|
Cai XL, Weigl M, Liu BH, Cheung EFC, Ding JH, Chan RCK. Delay discounting and affective priming in individuals with negative schizotypy. Schizophr Res 2019; 210:180-187. [PMID: 30598400 DOI: 10.1016/j.schres.2018.12.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/08/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
Previous studies have demonstrated that patients with schizophrenia and individuals with schizotypy experience decreased anticipatory pleasure. However, it is unclear whether this decrease is contributed by altered reward processing at the proximal or distal future. In order to investigate the preference for receiving rewards in the proximal or distal future for individuals with schizophrenia spectrum disorders, individuals with either high or low levels of negative schizotypy performed a delay discounting task under positive, neutral and negative affective priming conditions. Compared with individuals with low levels of negative schizotypy, individuals with high levels of schizotypy exhibited increased delay discounting, preferring to choose immediate but smaller rewards instead of delayed but larger rewards across all three affective priming conditions. Negative affective priming elevated discounting for both groups compared with both the positive and neutral affective conditions. After dividing delayed temporal distance into the proximal and distal future, the results showed that individuals with high levels of negative schizotypy exhibited more preference for immediate but smaller rewards in the distal instead of proximal future compared with controls. Our results suggest that individuals with high levels of negative schizotypy have altered anticipatory reward processing, which is mainly attributed to alterations in representing rewards in the distal future. These findings extend the alterations in representing reward values from schizophrenia patients to schizotypal individuals, and suggest that diminished anticipatory pleasure in schizophrenia spectrum disorders may be due to changes in processing anticipatory rewards in the distal future.
Collapse
Affiliation(s)
- Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing 100190, PR China; Sino-Danish Center for Education and Research, Beijing 100190, PR China
| | - Michael Weigl
- Experimental Neuropsychology Unit, Saarland University, Saarbrücken, Germany
| | - Bing-Hui Liu
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100190, PR China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong, Special Administrative Region, PR China
| | - Jin-Hong Ding
- Department of Psychology, Capital Normal University, Beijing 100037, PR China.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100190, PR China.
| |
Collapse
|
7
|
Martin EA, Hua JPY, Straub KT, Kerns JG. Explicit and Implicit Affect and Judgment in Schizotypy. Front Psychol 2019; 10:1491. [PMID: 31312158 PMCID: PMC6613436 DOI: 10.3389/fpsyg.2019.01491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Although emotion deficits in schizotypy have been reported, the exact nature of these deficits is now well understood. Specifically, for social anhedonia (SocAnh), there are questions about whether any decrease in positive affect only reflects an explicit bias not observed in other measures (e.g., implicit affect measure). At the same time, for individuals with elevated levels of perceptual aberrations or magical ideation (PerMag), there is some evidence of an increased influence of affect on judgment. It is also possible that the influence of implicit affect on judgment might be especially pronounced in PerMag; however, this has not been previously examined. The current study involved people with elevated levels of SocAnh (n = 95), elevated levels of PerMag (n = 62), and people with average or lower levels of both (n = 246). We found that SocAnh was associated with decreases in both explicit and implicit positive affect. We also found that PerMag was related to stronger relationships between implicit affect, both positive and negative, and a judgment task. These results suggest that decreased positive affect is a core feature of SocAnh and that a heightened influence of affect could be related to the development of peculiar beliefs/experiences associated with PerMag.
Collapse
Affiliation(s)
- Elizabeth A. Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Jessica P. Y. Hua
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Kelsey T. Straub
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - John G. Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| |
Collapse
|
8
|
Li LY, Fung CK, Moore MM, Martin EA. Differential emotional abnormalities among schizotypy clusters. Schizophr Res 2019; 208:285-292. [PMID: 30733171 DOI: 10.1016/j.schres.2019.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 01/20/2019] [Accepted: 01/27/2019] [Indexed: 12/31/2022]
Abstract
Schizotypy, a multidimensional personality organization that reflects liability to develop schizophrenia-spectrum disorders, has been associated with a number of emotional abnormalities. Yet, the exact nature of any emotional abnormalities in schizotypy is relatively unclear. Using an ethnically diverse nonclinical sample (N = 2637), the present study identified homogenous clusters of individuals based on positive and negative schizotypy dimensions and explored three interrelated domains of emotion traits closely tied to functional outcomes and quality of life: affective experience, emotional awareness, and meta-level emotions. Consistent with prior research, four schizotypy clusters were obtained: low ("nonschizotypic"), high positive, high negative, and mixed (high positive and high negative). Regarding emotion correlates of schizotypy clusters, the mixed cluster was found to be the most deviant on almost all emotion traits (e.g., heightened trait negative affect, diminished emotional clarity), suggesting that the effects of positive and negative schizotypy are additive. In addition, positive and negative schizotypy clusters were associated with differential abnormalities, with the negative cluster presenting a wider range of, and more severe, impairments compared to the low cluster (e.g., reduced trait positive affect and reduced attention to positive emotion). The current study highlights the heterogeneity in emotional traits among schizotypy dimensions and the importance of studying the mixed schizotypy in terms of emotional dysfunction.
Collapse
Affiliation(s)
- Lilian Yanqing Li
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Christie K Fung
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Melody M Moore
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA.
| |
Collapse
|
9
|
Li LY, Karcher NR, Kerns JG, Fung CK, Martin EA. The subjective-objective deficit paradox in schizotypy extends to emotion regulation and awareness. J Psychiatr Res 2019; 111:160-168. [PMID: 30772760 DOI: 10.1016/j.jpsychires.2019.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/15/2018] [Accepted: 01/30/2019] [Indexed: 01/22/2023]
Abstract
There is an emerging subjective-objective deficit paradox in schizotypy. Individuals with schizotypy report severe subjective complaints in several key functional domains commensurate with that of individuals with schizophrenia. However, objective assessments of the same domains show relatively intact performance. We examined whether this subjective-objective deficit paradox extends to two closely linked affective processes: emotion regulation and awareness. Individuals with elevated social anhedonia (SocAnh; n = 61) and elevated perceptual aberration/magical ideation (PerMag; n = 73) were compared to control participants (n = 81) on subjective and objective measures of emotion regulation and awareness. Subjective measures included self-report questionnaires assessing regulatory ability, attention to emotion, and emotional clarity. Implicit emotion regulation was assessed by the Emotion Regulation-Implicit Association Test (ER-IAT) while objective emotional awareness was assessed by the Levels of Emotional Awareness Scale (LEAS), a performance-based test. Results showed that both SocAnh and PerMag groups reported notable deficits in almost all subjective measures relative to controls (composite ds > 0.55). In contrast, performance on ER-IAT and LEAS was very similar to controls (composite ds < 0.11). The current study suggests that the subjective-objective deficit paradox extends to emotion regulation and awareness, highlighting the importance of higher-order cognitive bias in understanding emotional abnormalities in schizotypy.
Collapse
Affiliation(s)
- Lilian Yanqing Li
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Christie K Fung
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA.
| |
Collapse
|
10
|
Lyons M, Aksayli ND, Brewer G. Mental distress and language use: Linguistic analysis of discussion forum posts. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2018.05.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
11
|
Mammen JR, Java JJ, Rhee H, Butz AM, Halterman JS, Arcoleo K. Mixed-methods content and sentiment analysis of adolescents' voice diaries describing daily experiences with asthma and self-management decision-making. Clin Exp Allergy 2018; 49:299-307. [PMID: 30113733 DOI: 10.1111/cea.13250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/18/2018] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accurate symptom assessment remains challenging in teen populations. Little is known of usual symptom/response patterns, and self-reported paper diaries have traditionally low compliance rates. Therefore, we used concurrent digital voice diaries to capture daily asthma experiences. OBJECTIVE (a) To qualitatively explore usual symptom patterns and self-management responses and (b) to quantitatively explore relationships between symptom severity and sentiment scores (a marker of emotional response to events). METHODS Fourteen minority and nonminority teenagers (age 13-17) with controlled (50%) and uncontrolled asthma used digital recorders to report about their asthma once daily over 14 days. Dairy entries were coded for symptom frequency, severity, type, and self-management responses, while sentiment analysis was used to evaluate the emotional valence of diary entries and to explore whether increased symptom levels correlated with greater negative sentiment. RESULTS Symptom frequency and severity recorded in voice diaries were much higher than teens indicated at baseline and were discordant with clinical assessments of asthma control. Of 175 entries, teens had symptoms 69.1% of days (121/175) and severe symptoms on one-third of these. Atypical symptoms (coughing, throat clearing) were reported twice as often as traditional symptoms (wheezing, chest tightness) and often not recognized as asthma, but rather attributed to being "sick" (25.6% of symptom days). Teens frequently minimized symptoms, used rescue and controller medication inconsistently, and resorted to alternative strategies to manage symptoms. Sentiment was not significantly correlated with assessed control (β = 0.14, P = 0.28), but for teens reporting severe symptoms, sentiment scores decreased by 0.31 relative to teens without symptoms (P = 0.006). CONCLUSIONS AND CLINICAL RELEVANCE Teens may minimize symptoms and have greater symptom frequency and severity than is recognized by themselves or providers. Screening for specific symptoms including coughing, throat clearing, and respiratory illness may be needed to identify those experiencing burden from asthma.
Collapse
Affiliation(s)
- Jennifer R Mammen
- University of Rhode Island College of Nursing, Kingston, Rhode Island.,University of Rochester School of Nursing, Rochester, New York
| | - James J Java
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Hyekyun Rhee
- University of Rochester School of Nursing, Rochester, New York
| | - Arlene M Butz
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | | |
Collapse
|