Direct and Indirect Longitudinal Associations of Mother and Father Engagement in Middle Childhood on Adolescent Externalizing and Internalizing Behaviors

Parent engagement is an important aspect of parenting during childhood. However, little is known about the unique longitudinal associations of mother and father engagement with adolescents' externalizing and internalizing problem behaviors. This study uses Future of Families and Child Wellbeing Study data to examine the potential direct and indirect associations of parent engagement at age 9 on adolescent externalizing and internalizing behaviors at age 15. The analytic sample size is 1349, and at age 9, the mean age of children was 9.40 years (SD = 0.37). Forty-eight percent of children were female and 68% of them were from the married families. The results show that while controlling for mother engagement, higher father engagement at age 9 was directly associated with fewer adolescent internalizing behaviors, only among adolescent boys and in married families. In addition, among adolescent boys, father engagement had an indirect association with externalizing behaviors through father-child closeness. Mother engagement, however, is only found to have an indirect association with adolescents' externalizing and internalizing behaviors through maternal hostility (while controlling for father engagement). The results for mother engagement held for boys and in married families only. The findings indicate that both mother and father engagement during childhood is important and helpful to prevent adolescent problem behaviors directly or indirectly via parent-child relationship.

Dual Pandemics: Race-Related COVID Stress and Mental Health Outcomes in Black Individuals

Black individuals have been disproportionately affected by the COVID-19 pandemic, likely due in part to historically rooted stressors that lie at the intersection of the COVID-19 pandemic and racism. We used secondary data from The Association of Black Psychologists' multi-state needs assessment of 2480 Black adults to examine the link between race-related COVID stress (RRCS) and mental health outcomes. We also examined the moderating roles of everyday discrimination, cultural mistrust, Black activism, Black identity, and spirituality/religiosity in these associations. T-tests revealed that several demographic and cultural factors are associated with RRCS endorsement. A series of regression analyses showed that endorsement of RRCS is associated with higher psychological distress and lower well-being, above and beyond several sociodemographic characteristics. While traditional cultural protective factors did not buffer against the effects of RRCS on mental health, cultural mistrust strengthened the positive association between RRCS and psychological distress; nonetheless, the association of cultural mistrusts with psychological distress was only seen in those who endorsed RRCS. We provide recommendations for policymakers, clinicians, and researchers to consider the impact of RRCS when addressing Black mental health and well-being in the age of COVID-19.

Specificity and valence of adolescents' turning point memory narratives: Relationships with depressive symptoms over time

Although recent research suggests that, for community youth, greater specific (episodic) detail in self-relevant turning point memory narratives predicts depressive symptoms over time, no research has investigated whether the narratives' specificity similarly predicts depression. Therefore, we investigated whether recalling a specific (unique, 24-hour or less) turning point narrative predicted youth depressive symptoms concurrently and across 6 months (Study 1), and, for a subset of participants, three years (Study 2). We also examined whether the valence of the implication of the experience for self (the resolution) explained additional variance and interacted with memory specificity. For Study 1 (N = 320, M = 16.9 years, 81% female), a specific (rather than a non-specific) turning point predicted greater depressive symptoms concurrently but not longitudinally, whereas a negative resolution predicted both concurrent and longitudinal depressive symptoms. The moderation result showed that a specific turning point predicted escalating depressive symptoms across six months when the resolution was negative. Study 2 (N = 68) additionally showed that a specific turning point predicted increased depressive symptoms three years later. These findings contrast with research suggesting that specific memories are related to better mental health and highlight the complexity of the role of memory in emerging youth depression.

Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life

Quality of life may be understood as a multidimensional evaluation of life circumstances in relation to values, expectations, and perceived well-being. Quality of life is thus dependent on the subjective perception of the current life situation, not only objective circumstances. According to metacognitive theory, metacognition guides the appraisal of inner experiences (i.e., thoughts and feelings) and influences how one relates to external stressors. Hence, dysfunctional metacognitive beliefs and the cognitive attentional syndrome (CAS), which includes perseverative thinking, threat monitoring and ineffective coping strategies, may negatively influence subjective quality of life. Therefore, we aimed to investigate if metacognitive beliefs and CAS strategies were associated with quality of life. A sample of 503 participants (77.1% women, mean age 41.0, SD = 11.5) completed the metacognitions questionnaire 30 (MCQ-30), the CAS-1 and the quality of life scale (QOLS). We used structural equation modelling (SEM) to estimate associations between the variables founded in metacognitive theory. The results of the SEM showed a significant direct relationship between metacognitive beliefs and quality of life. CAS strategies mediated the effect of metacognitive beliefs on quality of life. Higher level of metacognitive beliefs was associated with greater use of CAS strategies, which in turn was associated with lower quality of life. Further, more CAS strategies were associated with lower quality of life. The results support the generic metacognitive model and suggest that stronger endorsement of dysfunctional metacognitive beliefs and corresponding CAS strategies are associated with lower quality of life. This observation held even when controlling for relevant covariates and suggests that modifying metacognitive beliefs may impact on subjective quality of life.

Increased plasminogen activator inhibitor-1 (PAI-1) and its associations with metabolic risk in healthy young adults with early life stress

OBJECTIVES

We aimed to characterize the interplay between early life stress (ELS), metabolic syndrome (MetS), and plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of the fibrinolytic system implicated in cardiometabolic diseases. We also examined the understudied intersection of ELS, physical activity and PAI-1.

METHODS

Healthy young adults ages 18-40 (N=200; 68% female) were recruited from the community. Participants with ELS (N=118) experienced childhood maltreatment, and the majority (n=92) also experienced childhood parental loss. Control participants (N=82) had no history of childhood maltreatment or parental loss. Participants had no current cardiometabolic or thrombotic conditions. Fasting plasma samples were assessed for markers of metabolic risk and total PAI-1 using the Bio-Plex Pro Human Diabetes Panel (Bio-Rad Laboratories). A composite metabolic risk z-score (MetS risk) was computed from the mean standardized z-scores of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, total cholesterol, LDL and HLD cholesterol, fasting plasma glucose, and hemoglobin A1c.

RESULTS

We found that a history of ELS was linked to both higher PAI-1 levels and a higher MetS risk score. ELS was associated with a higher MetS Z-score in adulthood via increased circulating PAI-1 levels (Average Causal Mediation Effect [ACME]= 0.07, p = 0.036). ELS was also linked to increased PAI-1 levels via greater MetS z-scores (ACME = 0.02, p < 0.001). There was a significant interaction effect of ELS and exercise on PAI-1 levels (p = 0.03), such that engaging in higher levels of daily exercise was linked to lower PAI-1 levels in individuals with ELS.

CONCLUSION

Healthy young adults with ELS have elevated PAI-1 levels and metabolic risk scores. Among individuals with ELS, exercise is linked to lower PAI-1 levels, suggesting a potential direction for early intervention.

Using Monte Carlo Simulation to Forecast the Scientific Utility of Psychological App Studies: A Tutorial

Mobile applications offer a wide range of opportunities for psychological data collection, such as increased ecological validity and greater acceptance by participants compared to traditional laboratory studies. However, app-based psychological data also pose data-analytic challenges because of the complexities introduced by missingness and interdependence of observations. Consequently, researchers must weigh the advantages and disadvantages of app-based data collection to decide on the scientific utility of their proposed app study. For instance, some studies might only be worthwhile if they provide adequate statistical power. However, the complexity of app data forestalls the use of simple analytic formulas to estimate properties such as power. In this paper, we demonstrate how Monte Carlo simulations can be used to investigate the impact of app usage behavior on the utility of app-based psychological data. We introduce a set of questions to guide simulation implementation and showcase how we answered them for the simulation in the context of the guessing game app Who Knows (Rau et al., 2023). Finally, we give a brief overview of the simulation results and the conclusions we have drawn from them for real-world data generation. Our results can serve as an example of how to use a simulation approach for planning real-world app-based data collection.

Cognitive phenotypes in patients with drug-resistant temporal lobe epilepsy: Relationships with cortisol and affectivity

OBJECTIVE

Drug-resistant temporal lobe epilepsy (TLE) is a neurological disorder characterized by cognitive deficits. This study examined whether patients with TLE and different cognitive phenotypes differ in cortisol levels and affectivity while controlling for demographic and clinical variables. Methods: In this cross-sectional study, 79 adults with TLE underwent neuropsychological evaluation in which memory, language, attention/processing speed, executive function, and affectivity were assessed. Six saliva samples were collected in the afternoon to examine the ability of the hypothalamic-pituitary-adrenal (HPA) axis to descend according to the circadian rhythm (C1 to C6). The cortisol area under the curve concerning ground (AUCg) was computed to examine global cortisol secretion.

RESULTS

Three cognitive phenotypes were identified: memory impairment, generalized impairment, and no impairment. The memory-impairment phenotype showed higher cortisol levels at C4, C5, and C6 than the other groups (p = 0.03, η2 = 0.06), higher cortisol AUCg than the generalized-impairment phenotype (p = 0.004, η2 = 0.14), and a significant reduction in positive affectivity after the evaluation (p = 0.026, η2 = 0.11). Higher cortisol AUCg and reductions in positive affectivity were significant predictors of the memory-impairment phenotype (p < 0.001; Cox and Snell R2 = 0.47).

CONCLUSIONS

Patients with memory impairment had a slower decline in cortisol levels in the afternoon, which could be interpreted as an inability of the HPA axis to inhibit itself. Thus, chronic stress may influence hippocampus-dependent cognitive function more than other cognitive functions in patients with TLE.

Relations Between Neighborhood Disadvantage and Electrocortical Reward Processing in Youth at High and Low Risk for Depression

Neighborhood-level disadvantage during childhood is a determinant of health that is hypothesized to confer risk for psychopathology via alterations in neuro-affective processing, including reward responsiveness. However, little research has examined the impact of socioeconomic disadvantage assessed at the community-level on reward processing, which may have important implications for targeted dissemination efforts. Furthermore, not all youth exposed to neighborhood disadvantage may exhibit alterations in reward reactivity, highlighting the need to consider factors that may exacerbate risk for blunted reward reactivity. The current study examined associations between geocoded indices of neighborhood disadvantage and electrocortical reward responsivity in youth and tested whether findings were moderated by maternal history of depression. The sample included 137 youth recruited for studies on the intergenerational transmission of depression. Neighborhood disadvantage was assessed using the Area Deprivation Index (ADI) while the reward positivity (RewP), an event-related potential, indexed reward response. Results revealed a significant interaction between ADI and maternal history of depression on youth RewP, such that greater neighborhood disadvantage was significantly associated with lower reward responsiveness, but only for youth with a maternal history of depression. Results were maintained controlling for youth internalizing symptoms and individual-level socioeconomic factors. Findings suggest that neighborhood disadvantage may impact youth neural reward processing, at least partially independently of individual risk factors, for youth with a maternal history of depression. If replicated, results suggest intervention efforts may be implemented at the community level to enhance reward responsiveness, specifically for youth living in low-resourced neighborhoods with a maternal history of depression.

Indirect and direct contributions of executive functions to reading comprehension

In the current study, we investigated the role of executive functions in explaining how word recognition and language comprehension jointly predict reading comprehension in multilingual and monolingual students (Grades 1 and 2). Specifically, mediation and moderation models were tested and compared to offer a more nuanced understanding of the role of executive functions in reading comprehension. The results provided support for the mediation model in which executive functions indirectly contribute to reading comprehension via word recognition and language comprehension in both language groups. In addition, executive functions directly predicted reading comprehension (i.e., partial mediation). These findings suggest that executive functions serve as general cognitive processes that support word recognition, language comprehension, and reading comprehension (i.e., direct contribution) as well as facilitate connecting word recognition and language comprehension in support for reading comprehension (i.e., indirect contribution). These findings are consistent with prominent models of reading comprehension.

FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers

OBJECTIVE

To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers.

METHODS

A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme.

RESULTS

A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity.

CONCLUSIONS

Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

Dysfunctional Attitudes Versus Metacognitive Beliefs as Within-Person Predictors of Depressive Symptoms Over Time

Understanding within-person variation between theorized mechanisms of disorder and depressive symptoms can help identify targets for interventions. Cognitive models of depression hypothesize dysfunctional attitudes as underlying vulnerability factors, while the metacognitive model places emphasis on dysfunctional metacognitive beliefs. However, no previous study has tested the relative importance of change in dysfunctional attitudes and metacognitive beliefs as predictors of change in depressive symptoms within individuals. In a sample of 1,418 individuals measured at four time-points separated by 5-week intervals, a multilevel model approach was used to test the relative importance of change in dysfunctional attitudes and metacognitive beliefs as predictors of change in depressive symptoms. Change in dysfunctional attitudes and metacognitive beliefs predicted change in depressive symptoms over time. However, change in metacognitive beliefs and in particular negative metacognitive beliefs and judgements of cognitive confidence were significantly stronger predictors of change in depressive symptoms compared to dysfunctional attitudes. Furthermore, change in metacognitive beliefs predicted change in dysfunctional attitudes beyond change in depressive symptoms. These results suggest that metacognitive beliefs rather than dysfunctional attitudes might be more important for depressive symptoms over time within persons and that metacognitive change may also influence dysfunctional attitudes over time. Metacognitive beliefs are therefore a promising target for treatment and prevention aiming to reduce depressive symptoms, but replication of our results in clinical samples is warranted before more clear conclusions can be drawn.

Patterns of Gender Equitable Attitudes and Behaviors Among Young Men: Relationships With Violence Perpetration and Masculinity Ideologies

This study used latent profile analysis with data from 481 U.S. men to examine patterns of men's attitudes toward gender equity and their engagement in gender-equitable (GE) behaviors. Five resulting profiles included groups with (a) high endorsement of both GE attitudes and behaviors, (b) low endorsement of both, (c) mid-range endorsement of both, (d) strong endorsement of GE attitudes, but low engagement in action, and (e) low endorsement of GE attitudes but high participation in GE behavior. Worryingly, this last group reported higher rates of violence perpetration than other groups, while simultaneously reporting higher rates of participation in gender-based violence prevention actions.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care: A Cluster Randomized Clinical Trial

Importance

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive.

Objective

To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs).

Design, Setting, and Participants

The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3).

Interventions

Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone.

Main Outcomes and Measures

Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data.

Results

Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02).

Conclusions and Relevance

In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs.

Trial Registration

ClinicalTrials.gov Identifier: NCT03385629.

Missing Data Analysis

Methods for handling missing data in clinical psychology studies are reviewed. Missing data are defined, and a taxonomy of main approaches to analysis is presented, including complete-case and available-case analysis, weighting, maximum likelihood, Bayes, single and multiple imputation, and augmented inverse probability weighting. Missingness mechanisms, which play a key role in the performance of alternative methods, are defined. Approaches to robust inference, and to inference when the mechanism is potentially missing not at random, are discussed.

Treatments for undefined log ratios in matching analyses

A challenge in carrying out matching analyses is to deal with undefined log ratios. If any reinforcer or response rate equals zero, the logarithm of the ratio is undefined: data are unsuitable for analyses. There have been some tentative solutions, but they had not been thoroughly investigated. The purpose of this article is to assess the adequacy of five treatments: omit undefined ratios, use full information maximum likelihood, replace undefined ratios by the mean divided by 100, replace them by a constant 1/10, and add the constant .50 to ratios. Based on simulations, the treatments are compared on their estimations of variance accounted for, sensitivity, and bias. The results show that full information maximum likelihood and omiting undefined ratios had the best overall performance, with negligibly biased and more accurate estimates than mean divided by 100, constant 1/10, and constant .50. The study suggests that mean divided by 100, constant 1/10, and constant .50 should be avoided and recommends full information maximum likelihood to deal with undefined log ratios in matching analyses.

Community exposure to gun homicide and adolescents' educational aspirations

INTRODUCTION

Witnessing violence and violent victimization have detrimental effects on adolescents' emotional functioning and ability to envision and plan for their futures. However, research is limited on the impact of violence that occurs in adolescents' communities-whether or not it was witnessed or experienced firsthand. This paper investigated the associations between community exposure to gun homicide and adolescents' high school and college graduation aspirations.

METHODS

We analyzed data from the Future of Families and Child Wellbeing Study (N = 3031), a cohort study of children born 1998-2000 in 20 large US cities, merged with incident-level data on deadly gun violence from the Gun Violence Archive (2014-2017). Outcomes were reported by adolescents (girls and boys) during wave 6 (2014-2017) of the study, conducted when the children were 15 years of age. We employed ordinary least squares regression, ordered logistic regression, and multilevel stratification to examine the average and heterogeneous impacts of community exposure to gun homicide on adolescents' educational aspirations.

RESULTS

Community exposure to gun homicide was associated with reduced high school graduation aspirations, particularly among adolescents with the lowest risk of exposure to gun homicide. Gun homicide exposure was also associated with increased college graduation aspirations; this association was concentrated among adolescents with moderate-high risk of exposure.

CONCLUSIONS

Given the importance of education for job opportunities and the better health that accompanies education and occupational attainment, preventing early exposure to gun violence and providing institutional supports to help adolescents facing adversity realize their goals is essential to their long-term health and success.

Young adults with a history of substance use disorder experienced more negative mental health, social and economic outcomes during the COVID-19 pandemic period

BACKGROUND AND AIMS

For young adults, the disruptions brought by the COVID-19 pandemic to work, social relationships and health-care probably impacted normative life stage transitions. Disaster research shows that negative effects of these events can persist for years after the acute crisis ends. Pandemic-related disruptions may have been especially consequential for young adults with a history of substance use disorder (SUD). The current work aimed to measure the broad impact of the COVID-19 pandemic on young adults with and without a history of SUD.

DESIGN, SETTING AND PARTICIPANTS

Data were from a longitudinal panel of n = 4407 young adults across the United States surveyed repeatedly from 2014 to 2019 (aged 19-26 years, pre-pandemic) and again in 2021 (aged 28 years, mid-pandemic).

MEASUREMENTS

We fitted multi-level models to understand the association between SUD history and pandemic outcomes, controlling for potential confounders (socio-demographic and health measures). Outcomes included overall life disruption; mental health, social and economic impacts; substance use; and physical health.

FINDINGS

Young adults with a history of SUD reported greater life disruption (standardized β = 0.13-0.15, Ps < 0.015) and negative mental health impacts (standardized β = 0.12-0.14, Ps < 0.012), experienced approximately 20% more work-related stressors (relative risks = 1.18-1.22, Ps < 0.002) and 50% more home-related stressors (relative risks = 1.40-1.51, Ps < 0.001), and had two to three times the odds of increased substance use during the pandemic (odds ratios = 2.07-3.23, Ps < 0.001). Findings generally did not differ between those with a recent SUD diagnosis and those in recovery from SUD before the pandemic began.

CONCLUSIONS

United States young adults with a history of substance use disorder (SUD) reported more life disruption and greater negative physical and mental health, social and economic impacts during the COVID mid-pandemic period than young adults with no history of SUD.

Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas

INTRODUCTION

Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum.

METHODS AND ANALYSIS

We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals.

ETHICS AND DISSEMINATION

This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations.

TRIAL REGISTRATION NUMBER

NCT03081559.

Social connectedness and loneliness in school for autistic and allistic children

LAY ABSTRACT

Many previous studies reported that autistic children have fewer social connections. Yet, recent studies also show that autistic children more often feel lonely in school than allistic (i.e. non-autistic) children. This outcome seems to go against the traditional view that autistic children do not desire to have social connections. Therefore, this study aimed to find out how autistic and allistic children feel about their social connections. We included 47 autistic and 52 neurodiverse-allistic children from two special education primary schools (aged 8-13 years). We tested their social connections and loneliness in school, through a new approach. This new approach includes questionnaires, and sensors for tracking social contacts on playgrounds during school breaks. We found that allistic children felt more loneliness when they spent little time in social contacts during school breaks. Yet, autistic children felt more loneliness when their peers did not like to play with them. For these autistic children, feelings of loneliness may go beyond face-to-face contacts. Being liked as part of a peer group was key. Understanding differences in children's needs can lead to a more effective design for a welcoming school climate.

Using Graphs to Perform Effective Sensor-Based Human Activity Recognition in Smart Homes

There has been a resurgence of applications focused on human activity recognition (HAR) in smart homes, especially in the field of ambient intelligence and assisted-living technologies. However, such applications present numerous significant challenges to any automated analysis system operating in the real world, such as variability, sparsity, and noise in sensor measurements. Although state-of-the-art HAR systems have made considerable strides in addressing some of these challenges, they suffer from a practical limitation: they require successful pre-segmentation of continuous sensor data streams prior to automated recognition, i.e., they assume that an oracle is present during deployment, and that it is capable of identifying time windows of interest across discrete sensor events. To overcome this limitation, we propose a novel graph-guided neural network approach that performs activity recognition by learning explicit co-firing relationships between sensors. We accomplish this by learning a more expressive graph structure representing the sensor network in a smart home in a data-driven manner. Our approach maps discrete input sensor measurements to a feature space through the application of attention mechanisms and hierarchical pooling of node embeddings. We demonstrate the effectiveness of our proposed approach by conducting several experiments on CASAS datasets, showing that the resulting graph-guided neural network outperforms the state-of-the-art method for HAR in smart homes across multiple datasets and by large margins. These results are promising because they push HAR for smart homes closer to real-world applications.

Intergenerational transmission of maternal prenatal anxiety to infant fearfulness: the mediating role of mother-infant bonding

PURPOSE

This study is the first to directly investigate the mechanistic role of maternal bonding toward her infant in the early intergenerational pathway of risk from maternal anxiety to infant fearfulness.

METHODS

Mothers (N = 216; Mage=32.78) reported on their anxiety and bonding at four time-points between pregnancy and ten-months postpartum. At four and ten-months postpartum, infant temperamental precursors of anxiety were assessed through maternal report and observation.

RESULTS

Cross-lagged longitudinal path modeling indicated a significant link between prenatal maternal anxiety and infant temperamental fearful withdrawal at 10-months postpartum (R2 = 0.117), which was fully explained by decreased maternal bonding at one-month postpartum and increased infant temperamental negative reactivity at 4-months postpartum.

CONCLUSION

Results support the need to foster maternal bonding in preventive perinatal care, particularly in the context of maternal anxiety.

Real-world predictors of changes in fear of COVID-19 in the Japanese general population: a large-scale internet-based cohort study with 20,712 participants

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a respiratory infection that considerably impacts both physical and mental health. In particular, the prolonged nature of psychological issues associated with COVID-19 has become a concern. However, evidence based on longitudinal studies investigating the changes in fear of COVID-19 has been limited, posing a public health challenge.

METHODS

We investigated the predictors of changes in the Fear of COVID-19 Scale (FCV-19S) scores in the general Japanese population using data from a large-scale internet-based cohort study.

RESULTS

We included 20,712 study participants (mean age = 51.1 years, percentage of males = 49.9%). The baseline FCV-19S score for the research participants was 17.0, and one year later, the FCV-19S score decreased to 15.8. The predictors of increase in FCV-19S scores were older age, male sex, COVID-19 requiring oxygen therapy, higher baseline FCV-19S total score, severe psychological distress, never married, worsening subjective health status, a greater number of COVID-19 vaccinations, a history of alcohol dependency, and living with family members. Conversely, the predictors of decrease in FCV-19S scores included habitual alcohol intake, COVID-19 not requiring oxygen therapy and a higher household income. Our study was an internet-based survey focused on residents of Japan, which raises the possibility of selection bias and makes it unclear whether the findings can be extrapolated to other countries and cultures.

CONCLUSION

During the observation period, the FCV-19S scores significantly decreased. Severe COVID-19 requiring oxygen therapy within one year of baseline was the most impactful predictor of an increase in FCV-19S score. On the other hand, mild COVID-19 not requiring oxygen therapy was a predictor of a decrease in FCV-19S scores. Therefore, we believe that it is necessary to adopt individualized approaches stratified by the severity of the infection when addressing the fear of COVID-19.

Shyness and risk-taking during peer observation in children and adolescents

Although temperamental shyness is conceptualized as a trait marked by cautiousness, we know relatively little about its relation to risk-taking. We examined how shyness was related to opportunities for risk-taking while considering how social context (i.e., presence of peers) and developmental stage (i.e., children and adolescents) might influence this relation. In the current study, 198 children (Mage = 10.17 years) and 221 adolescents (Mage = 13.46 years) completed the Balloon Analogue Risk Task (BART) alone or during a peer observation manipulation. For children and adolescents, shyness was related to physiological arousal and self-reporting feeling anxious during the peer condition. However, peer observation did not influence the relation between shyness and behavioral responses during the BART. Across both alone and peer conditions, shyness was related to a longer response time for children and adolescents, which may reflect decisional conflict during risk-taking opportunities. Furthermore, shyness in children (but not in adolescents) was related to poorer performance (i.e., fewer points), whereas shyness was unrelated to risk-taking propensity (i.e., number of pumps) for both children and adolescents. Overall, although the presence of peers may induce anxiety during a risk-taking opportunity for children and adolescents higher in shyness, this does not appear to modify their risk-taking behaviors. Instead, shyer children and adolescents in general may take a longer time to decide whether to act in a risky manner, whereas shy children in particular may show poorer performance in obtaining a reward on a risk-taking task.

Serial Cascade Effects of Relative Deprivation and Anger Rumination on the Development of Social Aggression Over 2.5 Years in Emerging Adults

Although the mechanisms of development of aggression have been focused on day by day, the complicated effects of distal and proximal factors on the development of social aggression in emerging adults have not been uncovered. A serial cascade model of aggression was proposed to address this issue. A longitudinal investigation over 2.5 years was conducted to test this model by exploring the serial cascade effects of relative deprivation (a representative of distal factors) and anger rumination (a representative of proximal factors) on the development of social aggression. A total of 1113 Chinese university students (Mage = 18.95 ± 0.96, 63.10% female) from six universities in five areas participated in this study. The results suggest that developmental trajectories and longitudinal changes in anger rumination mediate the relationship between developmental trajectories and longitudinal changes in relative deprivation and social aggression, and developmental trajectories and changes in relative deprivation mediate the longitudinal relationship between anger rumination and social aggression. These findings support the serial cascade effects of distal and proximal factors on the development of aggression and expand upon the general aggression model (GAM).

Resilience as a moderator of the relationship between stress and different symptom dimensions of depression in adolescents with a history of childhood maltreatment: A multi-wave longitudinal study

BACKGROUND

Although childhood maltreatment is a key risk factor for the development of psychopathology including depression in later life, not all children who have been maltreated subsequently become depressed.

OBJECTIVE

The study aimed to examine the potentially moderating influence of resilience on the relationship between daily stress and different symptom dimensions of depression in adolescents with a history of childhood maltreatment.

PARTICIPANTS AND SETTING

A sample of students (n = 999) aged 12-16 years from middle schools with a history of childhood maltreatment participated in this study.

METHODS

A multi-wave longitudinal study was conducted over 12 months. At baseline, adolescent participants completed standardized self-report measures of resilience, depression, and daily stress. The measures of depression and stress were re-administered every three months for the subsequent 12 months. Multi-level modeling was undertaken to analyze the data.

RESULTS

In adolescents with a history of childhood maltreatment, lower resilience scores were associated with greater increases in depressed affect, absence of positive affect and somatic symptom, but not the interpersonal concerns symptom dimensions of depression following daily stress. Resilience is therefore as one explanation for the discrepant findings regarding the relationship between stress and different symptom dimensions of depression, especially with regard to the stress-related depressive dimensions.

CONCLUSION

Resilience appears to moderate the relationship between daily stress and depression and protect against developing depression in children who have been maltreated. Findings provide potential explanation for the effectiveness of resilience-related therapy in treating depressive symptoms.

Behavioral and social drivers of COVID-19 vaccination initiation in the US: a longitudinal study March─ October 2021

Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p < .01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p < .01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p < .01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial.

Application of machine learning techniques in population pharmacokinetics/pharmacodynamics modeling

Population pharmacokinetics/pharmacodynamics (pop-PK/PD) consolidates pharmacokinetic and pharmacodynamic data from many subjects to understand inter- and intra-individual variability due to patient backgrounds, including disease state and genetics. The typical workflow in pop-PK/PD analysis involves the determination of the structure model, selection of the error model, analysis based on the base model, covariate modeling, and validation of the final model. Machine learning is gaining considerable attention in the medical and various fields because, in contrast to traditional modeling, which often assumes linear or predefined relationships, machine learning modeling learns directly from data and accommodates complex patterns. Machine learning has demonstrated excellent capabilities for prescreening covariates and developing predictive models. This review introduces various applications of machine learning techniques in pop-PK/PD research.

Ophthalmic artery Doppler in women with hypertensive disorders of pregnancy: relationship to blood pressure control and renal dysfunction at 6-9 weeks postnatally

OBJECTIVES

To examine the postnatal course of ophthalmic artery (OA) Doppler in women with hypertensive disorders of pregnancy (HDP) and to evaluate the correlation between OA Doppler parameters and poor postnatal blood pressure control and renal dysfunction at 2-3 weeks and 6-9 weeks postnatally.

METHODS

This was a prospective cohort study of women with a singleton pregnancy and HDP seen at a tertiary pregnancy hypertension clinic between 2019 and 2021. Three visits were included: Visit 1, the last visit to the antenatal hypertension clinic within 2 weeks prior to delivery; Visit 2, at 2-3 weeks postnatally; and Visit 3, at 6-9 weeks postnatally. At each visit, maternal demographic characteristics, medical history, blood pressure and OA Doppler were obtained. In addition, fetal growth and fetal Dopplers were examined antenatally and, at 6-9 weeks postnatally, estimated glomerular filtration rate and proteinuria were quantified. Study participants were divided into four hypertension groups, according to longitudinal changes in blood pressure at the three visits. For the postnatal visits, hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg in the absence of antihypertensive medication, and SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg whilst taking antihypertensives. Group 1 was hypertensive at all three visits; Group 2 was hypertensive at Visits 1 and 2 but normotensive at Visit 3; Group 3 was hypertensive at Visits 1 and 3 but normotensive at Visit 2; and Group 4 was hypertensive at Visit 1 but normotensive at Visits 2 and 3. The longitudinal changes in mean arterial pressure (MAP), peak systolic velocity (PSV) 1, PSV2 and the ratio of PSV2/PSV1 over the three timepoints were examined by a repeated-measures, multilevel, linear mixed-effects analysis, controlling for maternal age, weight at presentation and use of antihypertensive medication. In addition, we examined the longitudinal change in OA Doppler parameters in women with different degrees of postnatal blood pressure control and in those with and those without renal dysfunction at 6-9 weeks postnatally.

RESULTS

A total of 108 women were recruited to the study, of whom 86 had new-onset hypertension and 22 had chronic hypertension. When controlling for maternal age, weight at presentation and use of antihypertensive medication, a significant decline in log10 MAP (P < 0.001), log10 PSV1 (P < 0.001) and log10 PSV2 (P = 0.01) was seen between Visits 1 and 3. Log10 PSVR did not change with time. When assessing OA Doppler against hypertension group, log10 PSV1 and log10 PSV2 did not differ between the hypertension groups, whilst Group 4 had a lower log10 PSVR compared with Group 1 (P < 0.01), Group 2 (P = 0.03) and Group 3 (P < 0.01). At 6-9 weeks postnatally, log10 PSVR was lower in those without compared to those with renal dysfunction (-0.021, P = 0.01), whilst log10 MAP, log10 PSV1 and log10 PSV2 values did not differ. Log10 PSVR did not change with time and remained at -0.12 (95% CI, -0.13 to -0.11) across the three visits.

CONCLUSIONS

In women with HDP, the OA-PSVR was significantly higher in those with labile or persistently raised blood pressure postnatally compared to women whose blood pressure normalized. Similarly, the OA-PSVR at 6-9 weeks postnatally was significantly higher in women with renal dysfunction vs those without dysfunction. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Psychological pain and sociodemographic factors classified suicide attempt and non-suicidal self-injury in adolescents

This study aimed to utilize machine learning to explore the psychological similarities and differences between suicide attempt (SA) and non-suicidal self-injury (NSSI), with a particular focus on the role of psychological pain. A total of 2385 middle school students were recruited using cluster sampling. The random forest algorithm was used with 25 predictors to develop classification models of SA and NSSI, respectively, and to estimate the importance scores of each predictor. Based on these scores and related theories, shared risk factors (control feature set) and distinct risk factors (distinction feature set) were selected and tested to distinguish between NSSI and SA. The machine learning algorithm exhibited fair to good performance in classifying SA history [Area Under Curves (AUCs): 0.65-0.87] and poor performance in classifying NSSI history (AUC: 0.61-0.68). The distinction feature set comprised pain avoidance, family togetherness, and deviant peer affiliation, while the control feature set included pain arousal, painful feelings, and crisis events. The distinction feature set slightly but stably outperformed the control feature set in classifying SA from NSSI. The three-dimensional psychological pain model, especially pain avoidance, might play a dominant role in understanding the similarities and differences between SA and NSSI.

Examining differential effects of an equity-focused schoolwide positive behavioral interventions and supports approach on teachers' equity in school discipline

Following a randomized controlled trial that showed effectiveness of an equity-centered positive behavioral interventions and supports (PBIS) professional development intervention on student discipline in elementary schools, we studied the extent to which the intervention had differential effects on individual teachers' use of exclusionary discipline. Using the sample of teachers from the randomized controlled trial (n = 348), we assessed whether (a) changes in teacher use of office discipline referrals over the course of 2 school years and (b) intervention acceptability were moderated by teacher demographic characteristics (e.g., race/ethnicity, experience) or teacher attitudes (e.g., awareness of biases and commitment to equity). Results from multilevel models using two discipline outcomes (i.e., office discipline referrals issued to Black students and equity in office discipline referrals) did not show significant moderation effects for any demographic or attitude variables. Results of intervention acceptability found that teachers with pre-existing commitments to bias reduction found the intervention more acceptable, although means were consistently high across the sample. Findings indicate that the intervention was similarly effective on teacher discipline practices, regardless of teacher demographics or pre-existing attitudes, lending more support to the intervention's promise.

The mediating roles of optimism, loneliness, and psychological distress in the association between a sense of community and meaning in life among older adults

A sense of community is known to be a protective factor for the well-being of older adults and meaning in life associated with positive mental outcomes. Nevertheless, there is a need to expand the knowledge of the role of a sense of community in meaning in life, particularly among older adults. Intending to broaden the empirical understanding from this perspective, the current study examined the mediating roles of optimism, loneliness, and psychological distress in the association between a sense of community and meaning in life. Participants included 740 community dwelling Israeli older adults (M = 71.96; SD = 5.81). Participants completed questionnaires on a sense of community, optimism, loneliness, psychological distress, meaning in life, and sociodemographic characteristics. A positive association was found between a sense of community with optimism, and a negative association with loneliness. A negative association between optimism with psychological distress and a positive link between loneliness with psychological distress was found, while a higher level of psychological distress was associated with a lower level of meaning in life. Practitioners should focus interventions with older adults on developing a sense of community, with the aim to promote optimism and, at the same time, reduce loneliness and thus decrease psychological distress while strengthening meaning in life.

Pain tolerance as a 'barrier' to nonsuicidal self-injury: A longitudinal study

Theoretical perspectives underscore that low pain tolerance may be a relevant 'barrier' to non-suicidal self-injury (NSSI). However, there is limited longitudinal work on the link between pain tolerance and NSSI, which is needed to assess if pain tolerance precedes NSSI engagement, and/or if NSSI precedes altered pain tolerance. Further, assessing both NSSI frequency and versatility (or number of NSSI methods), in addition to engagement, can provide a more nuanced understanding of the influence of pain on NSSI severity. In the present study, 1125 undergraduate students at a large university (72 % female, Mage = 17.96) reported on their NSSI frequency, NSSI versatility, and perceived pain tolerance. Four individual regressions were run to examine the potential bidirectional nature of the association between NSSI frequency and pain tolerance, and NSSI versatility and pain tolerance. Pain tolerance predicted both NSSI frequency and versatility over time. Neither NSSI frequency nor versatility predicted pain tolerance. Results suggest that high pain tolerance may be a risk factor for severe NSSI engagement.

Patterns and predictors of adolescent engagement in a mindfulness-based social-emotional learning program

INTRODUCTION

Although mindfulness-based interventions (MBIs) show promise for promoting positive youth development, little is known about student engagement in MBIs. Initial research presents mixed findings in MBI engagement related to participant characteristics, and there is a lack of research examining the influence of context on engagement, despite the critical role context plays in academic engagement. This study examines the contribution of student demographic characteristics and classroom context to MBI engagement.

METHODS

Survey engagement data were collected at three time points from 106 ninth grade students (Mage = 14.17 years, 60.4% female, 44.2% Black, 24.8% Hispanic/Latino) who participated in the Be CALM program during the 2021-2022 school year. Latent growth curve modeling was used to examine trajectory of student engagement and assess student and classroom predictors of engagement.

RESULTS

There was no overall change in the trajectory of student engagement, although variability was observed across classes. Identifying as Hispanic/Latino was associated with lower engagement (β = -.25, p = .008), although this did not appear to be related to program experience. Peer connections predicted engagement at the end of the program (β = .39, p < .001). Post hoc analyses suggested that student engagement may be related to teacher program delivery quality.

CONCLUSIONS

Student engagement in MBIs appears related to classroom context more than student characteristics, although further research with larger samples is needed to assess the link between engagement and program outcomes. Findings have implications for designing school-based MBIs and training school staff to deliver them in culturally responsive ways.

Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response

Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N = 521) participated in a randomized controlled trial which compared cognitive therapy, mindfulness-based stress reduction, behavior therapy and treatment as usual. Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: 1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; 2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; 3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the treatment as usual condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across cognitive therapy, mindfulness-based stress reduction and behavior therapy, as hypothesized by the Limit, Activate, and Enhance model if these 3 treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the 3 psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (eg, forced-based interventions) non-psychosocial approaches. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT02133976. PERSPECTIVE: This article examines potential predictors/moderators of response to psychosocial treatments for chronic pain. Results could guide efforts to match people to the most effective treatment type or kind.

Using Multiple Imputation to Account for the Uncertainty Due to Missing Data in the Context of Factor Retention

Although parallel analysis has been found to be an accurate method for determining the number of factors in many conditions with complete data, its application under missing data is limited. The existing literature recommends that, after using an appropriate multiple imputation method, researchers either apply parallel analysis to every imputed data set and use the number of factors suggested by most of the data copies or average the correlation matrices across all data copies, followed by applying the parallel analysis to the average correlation matrix. Both approaches for pooling the results provide a single suggested number without reflecting the uncertainty introduced by missing values. The present study proposes the use of an alternative approach, which calculates the proportion of imputed data sets that result in k (k = 1, 2, 3 . . .) factors. This approach will inform applied researchers of the degree of uncertainty due to the missingness. Results from a simulation experiment show that the proposed method can more likely suggest the correct number of factors when missingness contributes to a large amount of uncertainty.

Development and testing of a questionnaire on the expectations and experiences with wearing face masks in inpatient and day hospitals

BACKGROUND

The Covid-19 pandemic made wearing of face masks mandatory in the psychotherapeutic context. Against this background, the present study aimed to compare the expectations of patients undergoing day-hospital or inpatient treatment regarding wearing a mask in psychotherapy before the start of therapy with the final experience after the end of therapy. The study also investigated the extent to which expectations and experiences were influenced by other factors such as socio-demographic characteristics, patients' general attitudes towards wearing a mask, duration of treatment, or mental health diagnoses.

METHODS

Patients' expectations and experiences were recorded using two versions of a self-developed questionnaire: the pre-version, which was administered before the start of therapy and recorded expectations, and the post-version, which was administered after the end of therapy and recorded the final experiences. An exploratory factor analysis was conducted for the questionnaire's pre- and post-version. T-tests for paired samples were calculated to compare the patients' expectations regarding the extracted factors with the final experiences. Bivariate correlations were calculated to explore the association of other potential factors with expectations and experiences.

RESULTS

The exploratory factor analysis revealed a three-factor structure: communication barriers, self-confidence, and infection protection. The communication barriers expected by the patients before the start of the therapy turned out to be significantly higher than ultimately experienced after the therapy. Higher age correlated significantly negatively with expectations and experiences, with less self-confidence expected and experienced in therapy with a mask by older patients. There was a significant positive correlation between the expectations and the duration of treatment. Patients' general attitudes correlated significantly with their expectations and experiences.

CONCLUSION

Based on the results, wearing a mask does not appear to negatively impact the success of psychotherapy from the patient's perspective. However, patient-specific characteristics also appear to play a role in this context.

Brain activity during reappraisal and associations with psychotherapy response in social anxiety and major depression: a randomized trial

BACKGROUND

Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm.

METHODS

Participants were 75 treatment-seeking patients with SAD (n = 34) or MDD (n = 41) randomized to CBT (n = 40) or ST (n = 35). Before randomization, patients completed a cognitive reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment.

RESULTS

Results indicated that pre-treatment neural activity during reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported reappraisal improvement, regardless of treatment arm.

CONCLUSIONS

If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.

Self-regulatory and self-efficacy mechanisms of weight loss in women within a community-based behavioral obesity treatment

Given the traditional methods of treating obesity through education on controlling eating and increasing exercise have largely failed beyond the very short term, a more intensive focus on psychosocial correlates of those weight-loss behaviors has been suggested. Multiple behavioral theories incorporate self-regulation, self-efficacy, and mood; however, their interrelations and effects over both the short and long term within cognitive-behavioral obesity treatments remain unclear. Within a novel community-based program with women with obesity who had either low (n = 29) or high (n = 71) mood disturbance scores, there were significant improvements in exercise- and eating-related self-regulation and eating-related self-efficacy-primary targets of that intervention-with no significant difference in those changes by mood disturbance grouping. Changes in the summed exercise- and eating-related self-regulation scores significantly mediated relationships between changes in eating-related self-efficacy and weight (over both 6 and 12 months). There were similar results with mediation assessed via the extent exercise-related self-regulation carried over to eating-related self-regulation. In both of those models a reciprocal relationship between self-regulation and self-efficacy changes was indicated. In serial multiple mediation equations, paths of changes in exercise-related self-regulation → eating-related self-regulation → eating-related self-efficacy → weight were significant. However, paths were not significant when change in self-efficacy was entered as the predictor (initial) variable. Findings suggest viability in first focusing on exercise-related self-regulation, then eating-related self-regulation, in the course of increasing self-efficacy and probabilities for inducing enough sustained weight loss to improve obesity-associated health risks. Benefits of field-based research findings generalizing to weight-management applications were suggested.

The effect of physical activity on anxiety symptoms among children and adolescents with mental health disorders: a research brief

Background

Anxiety is prevalent among children and adolescents (termed youths), and leads to reduced quality of life, disability, loss of education and reduced life-span. Physical activity has shown promising effects on symptoms of anxiety in adult populations, and an increasing amount of research has also demonstrated some effect in youth. However, physical activity is not widely used in youth mental health care, and research is very limited.

Methods/design

This single arm, pre-post study explores the effect of a manualized physical activity-based 14-session intervention termed Confident, Active and Happy Youth. Participants are youth attending specialized mental health care (N=51, M age = 13.4, SD = 2.2). Changes in anxiety symptoms are examined using mixed models with residual maximum likelihood (REML). The potential effect of anxiety subtype differences, participant age, comorbidity, and time spent in out-patient care are explored.

Results

Youths did not report any effect on anxiety symptoms after participation in CAHY, however, their parents report a significant reduction in youth's anxiety symptoms in general (b = -0.11, 95%, CI: -0.21 to -0.01) and specifically for social phobia (b = -0.19, 95% CI: -0.35 to -0.03). Age and comorbidity showed no significant effect on anxiety symptoms post treatment. Prior treatment time in youth mental health care demonstrated inconclusive results.

Conclusion

The study finds initial evidence of symptomatic change in a clinical population of youth's receiving a physical activity-based intervention. Our research provides preliminary support for physical activity as a supplementary treatment method for mental health disorders among youths.

Clinical Trial Registration

clinicaltrials.gov, NCT05049759.

Analysis of Missingness Scenarios for Observational Health Data

Despite the extensive literature on missing data theory and cautionary articles emphasizing the importance of realistic analysis for healthcare data, a critical gap persists in incorporating domain knowledge into the missing data methods. In this paper, we argue that the remedy is to identify the key scenarios that lead to data missingness and investigate their theoretical implications. Based on this proposal, we first introduce an analysis framework where we investigate how different observation agents, such as physicians, influence the data availability and then scrutinize each scenario with respect to the steps in the missing data analysis. We apply this framework to the case study of observational data in healthcare facilities. We identify ten fundamental missingness scenarios and show how they influence the identification step for missing data graphical models, inverse probability weighting estimation, and exponential tilting sensitivity analysis. To emphasize how domain-informed analysis can improve method reliability, we conduct simulation studies under the influence of various missingness scenarios. We compare the results of three common methods in medical data analysis: complete-case analysis, Missforest imputation, and inverse probability weighting estimation. The experiments are conducted for two objectives: variable mean estimation and classification accuracy. We advocate for our analysis approach as a reference for the observational health data analysis. Beyond that, we also posit that the proposed analysis framework is applicable to other medical domains.

Predictors of somatic symptoms during the COVID-19 pandemic: a national longitudinal survey in Japan

OBJECTIVES

The COVID-19 pandemic has highlighted the long-term consequences of SARS-CoV-2 infection, termed long COVID. However, in the absence of comparative groups, the differentiation of disease progression remains difficult, as COVID-19 symptoms become indistinguishable from symptoms originating from alternative etiologies. This study aimed to longitudinally investigate the association between COVID-19 exposure and the somatic symptoms in the Japanese general population.

DESIGN

This was a longitudinal cohort study with 1-year follow-up.

SETTING AND PARTICIPANTS

Longitudinal data from 19 545 individuals who participated in the Japan Society and New Tobacco Internet Survey (JASTIS) 2022 and 2023 were included. In this study, we used data from the 2022 JASTIS as baseline data and the 2023 JASTIS as follow-up data. Based on questionnaire responses, respondents were classified into three categories of exposure to COVID-19.

OUTCOME MEASURES

The somatic symptoms were assessed by the Somatic Symptom Scale-8 (SSS-8). Using generalised linear models adjusted for baseline covariates, we calculated the ORs of having very high somatic symptoms assessed by SSS-8, attributable to COVID-19 exposure (no COVID-19 cases as the reference group).

RESULTS

Follow-up completers were divided into three groups according to COVID-19 exposure (no COVID-19, n=16 012; COVID-19 without O2 therapy, n=3201; COVID-19 with O2 therapy, n=332). After adjusting for all covariates, COVID-19 cases with O2 therapy had a significant positive association (OR 7.60, 95% CI 5.47 to 10.58) with a very high somatic symptoms burden while other COVID-19 exposure groups did not. Pre-existing physical and psychological conditions were also associated with increased risk of somatic symptoms.

CONCLUSION

The findings of our study suggest that the severity of COVID-19 symptoms requiring O2 therapy in the acute phase led to high somatic symptoms. Pre-existing conditions were also associated with a subsequent risk of somatic symptoms.

Hostile Masculinity, Male Peer Support for Violence, and Problematic Anger: Linking Childhood Abuse to Men's Partner Violence Perpetration

Child abuse and masculinity have been linked to intimate partner violence (IPV) perpetration. However, there is a lack of work examining multiple aspects of masculinity as links between early abuse experiences and men's IPV perpetration. Grounded in notions of gendered power and patriarchy, this study aimed to examine hostile masculinity, male peer support for violence against women, and problematic anger as aspects of masculinity connecting childhood victimization and men's violence against women. Structural equation modeling results demonstrated that childhood adversity was indirectly related to IPV perpetration via the proposed factors. However, various patterns emerged based on the type of childhood abuse experienced. Practice-based implications are offered.

The Health4Life e-health intervention for modifying lifestyle risk behaviours of adolescents: secondary outcomes of a cluster randomised controlled trial

OBJECTIVES

To investigate the effectiveness of a school-based multiple health behaviour change e-health intervention for modifying risk factors for chronic disease (secondary outcomes).

STUDY DESIGN

Cluster randomised controlled trial.

SETTING, PARTICIPANTS

Students (at baseline [2019]: year 7, 11-14 years old) at 71 Australian public, independent, and Catholic schools.

INTERVENTION

Health4Life: an e-health school-based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app.

MAIN OUTCOME MEASURES

Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol-related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous).

RESULTS

A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow-up survey, 5698 (85.8%) two or more follow-up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57-2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64-1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72-1.38); tobacco use frequency: relative difference, 0.03 (95% CI, -0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, -0.34 (95% CI, -1.16 to 0.49) days per 30 days; device use time: relative difference, -0.07 (95% CI, -0.29 to 0.16) hours per day.

CONCLUSIONS

Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e-health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective).

A Description of Missing Data in Single-Case Experimental Designs Studies and an Evaluation of Single Imputation Methods

Missing data is inevitable in single-case experimental designs (SCEDs) studies due to repeated measures over a period of time. Despite this fact, SCEDs implementers such as researchers, teachers, clinicians, and school psychologists usually ignore missing data in their studies. Performing analyses without considering missing data in an intervention study using SCEDs or a meta-analysis study including SCEDs studies in a topic can lead to biased results and affect the validity of individual or overall results. In addition, missingness can undermine the generalizability of SCEDs studies. Considering these drawbacks, this study aims to give descriptive and advisory information to SCEDs practitioners and researchers about missing data in single-case data. To accomplish this task, the study presents information about missing data mechanisms, item level and unit level missing data, planned missing data designs, drawbacks of ignoring missing data in SCEDs, and missing data handling methods. Since single imputation methods among missing data handling methods do not require complicated statistical knowledge, are easy to use, and hence are more likely to be used by practitioners and researchers, the present study evaluates single imputation methods in terms of intervention effect sizes and missing data rates by using a real and hypothetical data sample. This study encourages SCEDs implementers, and also meta-analysts to use some of the single imputation methods to increase the generalizability and validity of the study results in case they encounter missing data in their studies.

Covariate modeling in pharmacometrics: General points for consideration

Modeling the relationships between covariates and pharmacometric model parameters is a central feature of pharmacometric analyses. The information obtained from covariate modeling may be used for dose selection, dose individualization, or the planning of clinical studies in different population subgroups. The pharmacometric literature has amassed a diverse, complex, and evolving collection of methodologies and interpretive guidance related to covariate modeling. With the number and complexity of technologies increasing, a need for an overview of the state of the art has emerged. In this article the International Society of Pharmacometrics (ISoP) Standards and Best Practices Committee presents perspectives on best practices for planning, executing, reporting, and interpreting covariate analyses to guide pharmacometrics decision making in academic, industry, and regulatory settings.

High Versus Low Intensity Summer Adolescent ADHD Treatment Effects on Internalizing, Social, and Self-Esteem Problems

The current study aims to evaluate the effectiveness of a high-intensity (HI) versus a low-intensity (LI) skills-based summer intervention delivered to adolescents with ADHD by school staff in improving depressive symptoms, anxiety symptoms, social problems, and self-esteem. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to an HI versus an LI intervention (n = 218) or recruited into an untreated comparison group (n = 107). Group x time and group x grade x time one-year outcome trajectories were compared using linear mixed models. Across the transitional year (sixth or ninth grade), adolescents in the HI group were found to experience significantly greater decreases in depressive symptoms (p = .022, d = .25) compared to the LI group. There was no significant impact of the HI intervention (vs. LI) on anxiety symptoms (p = .070, d = .29), social problems (p = .054, d = .34), or self-esteem (p = .837, d = 0.21); however, secondary analyses of the non-randomized untreated comparison group indicated a significant effect of HI versus the untreated comparison group on social problems (p = .009, d = 43). These significant treatment effects suggest that comprehensive academic and organizational skills interventions for adolescents with ADHD may have a secondary impact of relieving adolescent depression for teens with this comorbidity. Given mixed evidence for the efficacy of the HI intervention on social skills, future work should further evaluate this effect.

The Utility of the Level of Personality Functioning Scale in Maternal Samples: A Brief Report

Maternal personality plays a role in how a mother parents her children and adolescents. Current trait-based measures of personality are acceptable for use in maternal samples, but the presence or absence of given personality traits might not be enough to describe how personality relates to parenting. The Level of Personality Functioning Scale (LPFS) could serve as a solution, as it was designed to capture level of dysfunction in personality without being reliant on specific personality traits. Research, however, has yet to demonstrate the LPFS as a useful measure of personality in maternal samples, thus the goal of this study. A sample of 123 mothers reported on behavioral problems in their adolescent-aged children and their own personality using both a trait-based measure and the LPFS. Our data showed that maternal reports on the LPFS were associated with maternal perceptions of adolescent behavioral problems, in addition to being an acceptable measure of personality in our maternal sample. We also provide support for incremental validity of the LPFS in our sample, as the LPFS uniquely predicted maternal perceptions of adolescent behavioral problems even after controlling for maternal personality traits. Our results are discussed in light of the limitations of the extant work on maternal personality and add to the literature by demonstrating that the LPFS is an acceptable and ubiquitous measure of personality in maternal samples.

Developmental Trajectories of Parental Self-Efficacy as Children Transition to Adolescence in Nine Countries: Latent Growth Curve Analyses

Little is known about the developmental trajectories of parental self-efficacy as children transition into adolescence. This study examined parental self-efficacy among mothers and fathers over 3 1/2 years representing this transition, and whether the level and developmental trajectory of parental self-efficacy varied by cultural group. Data were drawn from three waves of the Parenting Across Cultures (PAC) project, a large-scale longitudinal, cross-cultural study, and included 1178 mothers and 1041 fathers of children who averaged 9.72 years of age at T1 (51.2% girls). Parents were from nine countries (12 ethnic/cultural groups), which were categorized into those with a predominant collectivistic (i.e., China, Kenya, Philippines, Thailand, Colombia, and Jordan) or individualistic (i.e., Italy, Sweden, and USA) cultural orientation based on Hofstede's Individualism Index (Hofstede Insights, 2021). Latent growth curve analyses supported the hypothesis that parental self-efficacy would decline as children transition into adolescence only for parents from more individualistic countries; parental self-efficacy increased over the same years among parents from more collectivistic countries. Secondary exploratory analyses showed that some demographic characteristics predicted the level and trajectory of parental self-efficacy differently for parents in more individualistic and more collectivistic countries. Results suggest that declines in parental self-efficacy documented in previous research are culturally influenced.

Exposure to neighborhood violence, and laboratory-based and ambulatory cognitive task performance in adulthood

OBJECTIVE

Exposure to neighborhood violence may have negative implications for adults' cognitive functioning, but the ecological sensitivity of these effects has yet to be determined. We first evaluated the link between exposure to neighborhood violence and two latent constructs of cognitive function that incorporated laboratory-based and ambulatory, smartphone-based, cognitive assessments. Second, we examined whether the effect of exposure to violence was stronger for ambulatory assessments compared to in-lab assessments.

METHODS

We used data from 256 urban-dwelling adults between 25 and 65 years old (M = 46.26, SD = 11.07); 63.18% non-Hispanic Black, 9.21% non-Hispanic White, 18.41% Hispanic White, 5.02% Hispanic Black, and 4.18% other. Participants completed baseline surveys on neighborhood exposures, cognitive assessments in a laboratory/research office, and ambulatory smartphone-based cognitive assessments five-times a day for 14 days.

RESULTS

Exposure to neighborhood violence was associated with poorer performance in a latent working memory construct that incorporated in-lab and ambulatory assessments, but was not associated with the perceptual speed construct. The effect of exposure to neighborhood violence on the working memory construct was explained by its effect on the ambulatory working memory task and not by the in-lab cognitive assessments.

CONCLUSION

This study shows the negative effect that exposure to neighborhood violence may have on everyday working memory performance in urban-dwelling adults in midlife. Results highlight the need for more research to determine the sensitivity of ambulatory assessments to quantify the effects of neighborhood violence on cognitive function.