From loss to loneliness: The relationship between bereavement and depressive symptoms

Emotional vs. social loneliness and prolonged grief: a random-intercept cross-lagged panel model

Background: Bereavement following death, with loneliness as a prominent feature, can result in enduring stress and compromised health.Objective: Building on Weiss's ([1973]. Loneliness: The experience of emotional and social isolation. MIT Press) proposal of two distinct types of loneliness, this study investigated within-person associations between emotional loneliness (EL) and prolonged grief symptoms (PGS) (aim 1), as well as social loneliness (SL) and PGS (aim 2) over four years following spousal loss. Additionally, we examined the impact of gender, age, and education on the main factors.Methods: We used random-intercept cross-lagged panel modelling (RI-CLPM) to analyse self-reported data from 338 Danish spousal-bereaved adults (58% female; mean age = 72.1; range 65-81 years) on EL and SL (single-item questions) and PGS (Inventory of Complicated Grief, short version) at 6, 13, 18, and 48 months post-loss.Results: We found (1) within-person associations between EL and PGS; (2) no within-person associations between SL and PGS. In our model, PGS predicted EL over time, with no reciprocal effect. In contrast, PGS and SL were unrelated. Age did not link with EL, SL, or PGS. More years of education were associated with less EL and SL, but not with PGS. Gender influenced the association between SL and PGS.Conclusions: This study enhances our understanding of longitudinal, within-person associations between EL, SL, and PGS. Consistent with Weiss's (1973) relational theory of loneliness in widowhood, results highlight the unique role of EL. While replication is needed due to limitations like single-item measures and varying intervals, these findings emphasize EL's importance in widowhood and offer a basis for better understanding and addressing PGS. Monitoring the relationship between loneliness and grief may help healthcare providers offer timely, targeted interventions.

Prolonged grief, social contact, community belongingness: A representative study of loneliness among bereaved UK adults

BACKGROUND

Loneliness is a common experience among bereaved individuals, yet the extent to which prolonged grief, personal social contact, and community belongingness independently explain loneliness is not fully understood.

METHODS

We analyzed cross-sectional data from a nationwide, representative sample of 2520 adults in the UK who had lost a loved one. Hierarchical regressions were conducted in three steps, adding demographic and loss-related variables first, followed by personal contact and community belongingness, and then prolonged grief severity with loneliness as the outcome variable.

RESULTS

Bivariate correlations showed loneliness was significantly negatively associated with personal contact and community belongingness and positively associated with Prolonged Grief Disorder severity. In the final model, younger age, female gender, and lower income significantly predicted higher loneliness. Notably, community belongingness emerged as the strongest protective factor (β = -0.262), significantly outweighing the effect of personal social contact (β = -0.054). Higher prolonged grief also uniquely contributed to loneliness, with a non-linear relationship indicating a tipping point at severe grief levels that markedly exacerbated social isolation. Altogether, the final model explained approximately 24 % of the variance in loneliness.

CONCLUSION

These findings underscore that individuals who exhibit intense prolonged grief and possess weaker connections to their broader community are especially vulnerable to loneliness. While more frequent personal contact can provide emotional intimacy, fostering a sense of community appears to confer broader, more sustainable social benefits. Interventions that integrate psychological support for severe grief and opportunities for community engagement may be particularly effective in reducing bereavement-related loneliness.

Macaque mothers' responses to the deaths of their infants

Although it is understood that all humans grieve the death of close social partners, little empirical research has addressed animals' responses to death. In this study, we collected quantitative data on the behaviour of 11 bereaved rhesus macaque (Macaca mulatta) mothers at Cayo Santiago to the natural deaths of their infants and matched, non-bereaved controls. Our research focused on behavioural signs of grief, including loss of appetite, lethargy, increased stress and social withdrawal, highlighting that such responses are documented in the human literature, but could be found in mammalian taxa. Using mixed models, we found that, contrary to prediction, bereaved mothers spent less time resting than the non-bereaved control females in the first two weeks after their infants' deaths. There were no other behavioural markers of grief. We conclude that mothers showed a short-term behavioural response to their bereavement that does not match human's prolonged 'despair' grief. We propose that mothers' behavioural responses might be a form of 'protest' grief, as is seen in primate infants when separated from mothers and in humans, or do not grieve. We hope to advance the field of comparative thanatology by providing a framework and novel predictions for future studies in this area.

Demoralization's link to depression and anxiety symptoms: A network analysis

Demoralization represents a clinical syndrome conceptualized as maladaptive coping to a stressor associated with discouragement, feelings of hopelessness, helplessness, and a loss of meaning in life. It is a prevalent comorbidity in individuals with severe physical illnesses and affects a substantial proportion of the general population when facing global stressors like the COVID-19 pandemic. The main aim of the study was to test whether demoralization and features of depression and anxiety might reflect distinct entities within the general population, specifically in older adults, and to explore symptom interconnections, using a network psychometrics approach. The revised demoralization scale (DS-II) and the patient health questionnaire 4 (PHQ-4) were applied to a representative sample (N = 2434) from the German general population. Network structures were analyzed using exploratory graph analysis (EGA) to identify the most distinct symptom groupings and their relationships. Stability of networks and symptom groupings was tested using bootstrap procedures. EGA revealed unidimensionality within younger adulthood and a four-factor solution within older adults, reliably distinguishing PHQ-4 and DS-II items. The most central features of the network were worthlessness, pointlessness, helplessness, feeling trapped and low mood. Suicidal ideation was more closely related to DS-II worthlessness than to PHQ-4 items. The cross-sectional design and using PHQ-4 instead of more comprehensive measures of depression and anxiety were limitations. In conclusion, in general population, demoralization symptoms can be distinguished from lack of interest or pleasure and low mood. It might represent a valid psychological construct beyond clinical populations. Further investigation of diagnostic implications is encouraged.

Exploring Estimation Procedures for Reducing Dimensionality in Psychological Network Modeling

To understand psychological data, it is crucial to examine the structure and dimensions of variables. In this study, we examined alternative estimation algorithms to the conventional GLASSO-based exploratory graph analysis (EGA) in network psychometric models to assess the dimensionality structure of the data. The study applied Bayesian conjugate or Jeffreys' priors to estimate the graphical structure and then used the Louvain community detection algorithm to partition and identify groups of nodes, which allowed the detection of the multi- and unidimensional factor structures. Monte Carlo simulations suggested that the two alternative Bayesian estimation algorithms had comparable or better performance when compared with the GLASSO-based EGA and conventional parallel analysis (PA). When estimating the multidimensional factor structure, the analytically based method (i.e., EGA.analytical) showed the best balance between accuracy and mean biased/absolute errors, with the highest accuracy tied with EGA but with the smallest errors. The sampling-based approach (EGA.sampling) yielded higher accuracy and smaller errors than PA; lower accuracy but also lower errors than EGA. Techniques from the two algorithms had more stable performance than EGA and PA across different data conditions. When estimating the unidimensional structure, the PA technique performed the best, followed closely by EGA, and then EGA.analytical and EGA.sampling. Furthermore, the study explored four full Bayesian techniques to assess dimensionality in network psychometrics. The results demonstrated superior performance when using Bayesian hypothesis testing or deriving posterior samples of graph structures under small sample sizes. The study recommends using the EGA.analytical technique as an alternative tool for assessing dimensionality and advocates for the usefulness of the EGA.sampling method as a valuable alternate technique. The findings also indicated encouraging results for extending the regularization-based network modeling EGA method to the Bayesian framework and discussed future directions in this line of work. The study illustrated the practical application of the techniques to two empirical examples in R.

Unraveling depressive symptom networks: A three-year longitudinal study among Chinese junior high school adolescents

Adolescence is the peak period for the occurrence of mental health issues, particularly in the stage of junior high school. Depressive symptoms are among the most frequently experienced psychological problems. However, little is known about the symptom-level interaction features of depressive symptoms and the roles of different symptoms across the junior high school stage. To address these gaps, this study conducted a three-year longitudinal study that recruited 1301 Chinese junior high school adolescents (48.2% females; mean age = 12.46 ± 0.62, ranging from 11 to 14 in the first year). The Center for Epidemiological Studies Depression Scale was used to assess depressive symptoms. The regularized partial correlation network and the cross-lagged panel network models were used to explore the symptom-level interaction pattern. In regularized partial correlation networks, "I felt depressed" was a stable central symptom throughout the junior high school stage. Besides, "I felt lonely" and "I felt that people disliked me" were the other central symptoms in grade 7 and grade 8, and "I felt everything I did was an effort" played a central role in grade 9. Within cross-lagged panel networks, "I felt that people disliked me" and "I felt hopeless about the future" had important effects on predicting other depressive symptoms from grade 7 to 8 and from grade 8 to 9. By investigating the longitudinal interaction patterns of depressive symptoms among junior high school adolescents, the current study identifies core symptoms that could be potential prevention or intervention targets and provides a novel insight for understanding depressive symptoms during adolescence in depth.

A cross-sectional network analysis of successful aging in a resilience-based framework

Aging inevitably gives rise to many challenges and transitions that can greatly impact our (mental) well-being and quality of life if these are not controlled adequately. Hence, the key to successful aging may not be the absence of these stressors, but the ability to demonstrate resilience against them. The current study set out to explore how resilience and successful aging may intersect by investigating how various resilience capacity-promoting (protective) and resilience capacity-reducing (risk) factors relate to mental well-being and quality of life. Through a large-scale (N = 2000, age 55+, 30 factors) network analysis, we established the interplay between risk/protective factors from various domains, including demographics, (mental) health, (environmental) stress, lifestyle, coping/personality, and ageism. We revealed some unique pathways through which each of these factors contribute to individuals' mental well-being and/or quality of life, and interpreted these findings in terms of a resilience-based framework of successful aging. Our findings emphasize the complexity of factors that can impact quality of life and mental well-being in later life and can steer researchers and practitioners in devising efficacious, multi-pronged interventions that target risk and protective factors simultaneously, thereby maximizing their potential in boosting beneficial outcomes among older individuals.

Prolonged Grief Symptoms Predict Social and Emotional Loneliness and Depression Symptoms

A minority of bereaved individuals develops severe, persistent, and disabling grief, termed "prolonged grief." The International Classification of Diseases, eleventh edition (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) include such grief reactions as prolonged grief disorder (PGD). Loneliness is often experienced by bereaved persons and can have severe health consequences. Preliminary research suggests that loneliness may perpetuate grief, but prolonged grief may also aggravate loneliness. Since existing empirical research provides limited information on temporal relationships between both constructs, we aimed to fill this gap in knowledge. Bereaved adults (88% female, mean age 54 years) filled in questionnaires assessing general, social, and emotional loneliness and prolonged grief and depression symptoms across two time points, 6 months apart. Cross-lagged panel model analyses showed that prolonged grief symptoms predicted more severe general, social, and emotional loneliness, as well as more depression symptoms. Loneliness did not predict prolonged grief symptoms and depression symptoms. Depression symptoms did not predict prolonged grief symptoms and loneliness. Additionally, latent change score analyses demonstrated that within person changes in prolonged grief symptoms and loneliness were related. Findings are inconsistent with the notion that loneliness causes prolonged grief and depression. Possibly, severe grief could lead to stigmatization, reduced social support, and feeling socially disconnected, perpetuating loneliness and depression symptoms.

Genomic network analysis characterizes genetic architecture and identifies trait-specific biology

Pervasive genetic overlap across human complex traits necessitates developing multivariate methods that can parse pleiotropic and trait-specific genetic signals. Here, we introduce Genomic Network Analysis (GNA), an analytic framework that applies the principles of network modelling to estimates of genetic overlap derived from genome-wide association study (GWAS) summary statistics. The result is a genomic network that describes the conditionally independent genetic associations between traits that remain when controlling for shared signal with the broader network of traits. Graph theory metrics provide added insight by formally quantifying the most important traits in the genomic network. GNA can discover additional trait-specific pathways by incorporating gene expression or genetic variants into the network to estimate their conditional associations with each trait. Extensive simulations establish GNA is well-powered for most GWAS. Application to a diverse set of traits demonstrate that GNA yields critical insight into the genetic architecture that demarcate genetically overlapping traits at varying levels of biological granularity.

Effects of Information and Communication Technology Use on the Executive Function of Older Adults without Dementia: A Longitudinal Fixed-Effect Analysis

BACKGROUND

Impaired executive function is common in older adults. This study examined the causal relationship between the use of information and communication technology (ICT) and executive function in older adults over time.

METHOD

This study performed a secondary analysis of data from four waves (2016-2019) of the National Health and Aging Trends Study. A fixed-effect analysis was conducted to examine the effects of ICT on the executive function of older adults without dementia aged ≥65 years. This study analyzed data from 3,334 respondents.

RESULTS

We observed significant positive effects of ICT use on executive function over time (standardized β=0.043-0.045; 95% confidence interval, 0.001-0.043; p<0.05).

CONCLUSION

The current findings support the use of ICT as a protective approach to prevent decline in executive function in community-dwelling older adults.

Psychometric Properties of the Persian Version of the Inventory of Complicated Grief

The aim of this study was to investigate the psychometric properties of the Persian version of the Inventory Complicated Grief (ICG) including reliability, validity and factorial structure. In this cross-sectional study, 332 women and men bereaved at least 6 months from the adult population of Iran. The results showed Cronbach's alpha was found to be 0.94 for the scales overall score. Inventory Complicated Grief found a positive and significant correlation between the beck depression inventory (BDI) (r = .62, p < .001) and grief experience questionnaire (r = .74, p < .001). Still, he also found that there was a negative correlation between adult hope scale (r = -.44, p < .001). Furthermore, the results of the EFA result showed four factors on this scale. Overall, ICG showed good reliability and validity in Iranian population and it could be applied for assessing their Complicated Grief.

Testing the validity of the broaden-and build theory of positive emotions: a network analytic approach

Introduction

The Broaden-and-Build Theory of positive emotions is one of the best known and applied theories in Positive Psychology. It argues that positive emotions initiate an upward movement by opening up the mind and broadening thoughts and thus represents a counter model to the vicious circle-models of clinical psychology. The number of studies directly testing this theory in all components is scarce, ambiguities in the model impede clear inference.

Method

To draw a conclusive picture on within-model processes, we applied network modeling on the components of the theory across two studies (N 1 = 312; N 2 = 302).

Results

In both studies, the positive relationship between positive emotions, resources and life outcomes is well-supported, yet the role of broadening, as an intermediary component within these is questioned.

Discussion

As the broadening component consistently deviated from the model's predictions and thus did not contribute to the model as expected in either study, the validity of the Broaden-and-Build Theory in its current conceptualization is challenged, and our results point to the need to reassess the role of broadening.

A Network Approach to Understanding the Role of Executive Functioning and Alpha Oscillations in Inattention and Hyperactivity-Impulsivity Symptoms of ADHD

OBJECTIVE

ADHD is a prevalent neurodevelopmental disorder characterized by symptoms of inattention and hyperactivity-impulsivity. Impairments in executive functioning (EF) are central to models of ADHD, while alpha-band spectral power event-related decreases (ERD) have emerged as a putative electroencephalography (EEG) biomarker of EF in ADHD. Little is known about the roles of EF and alpha ERD and their interactions with symptoms of ADHD.

METHOD

We estimated network models of ADHD symptoms and integrated alpha ERD measures into the symptom network.

RESULTS

EF emerges as a bridge network node connecting alpha ERD and the hyperactivity/impulsivity and inattention symptoms. We found that EF most closely relates to a subset of symptoms, namely the motoric symptoms, "seat" (difficulty staying seated), and "runs" (running or climbing excessively).

CONCLUSIONS

EF functions as a bridge node connecting alpha ERD and the ADHD symptom network. Motoric-type symptoms and EF deficits may constitute important nodes in the interplay between behavior/symptoms, cognition, and neurophysiological markers of ADHD.

Are Sensory Experiences of One's Deceased Spouse Associated with Bereavement-Related Distress?

Following late-life spousal bereavement, sensory and quasi-sensory experiences of the deceased (SED) are commonly reported. This longitudinal study examined SED among 310 older widowed adults 6-10 (T1) and 18-20 (T2) months post loss. Reports of SED in the first 6-10 months after loss were associated with higher symptom levels of prolonged grief, post-traumatic stress, and loneliness at T1. Experiencers of SED were more likely to experience symptoms of prolonged grief and post-traumatic stress above cut-off scores at T1. Importantly, only a minority of the experiencers of SED displayed these elevated levels of bereavement-related distress. In addition, employing multi-level-modeling, a similar trajectory of decreasing bereavement-related distress over time was found for both experiencers and non-experiencers of SED. We argue that SED may be one of several potential reactions to bereavement, which should not be seen as an indicator of grief complications per se.

Social connectedness in older Urban African-American adults during the COVID-19 pandemic: the roles of education and partnership

OBJECTIVE

This study examined education, partnership status, and the moderating role of the lockdown period on social connectedness during the COVID-19 pandemic in a sample of urban African-American older adults.

METHODS

Five hundred thirty-four African-American adults living in Detroit (91.0% female, Mage = 74.53) reported demographic information pre-pandemic and answered one social connectedness questionnaire between April and December 2020.

RESULTS

Participants interviewed after the lockdown (post-June 2020) reported more loneliness than those interviewed during the lockdown (April-June, 2020). Married/partnered participants reported less loneliness and social isolation. Loneliness did not differ between those with high education levels interviewed during the lockdown compared to post-lockdown. However, among individuals with low education levels, those interviewed after the lockdown reported more loneliness than those interviewed during the lockdown period.

CONCLUSION

Our findings suggest partnership status is associated with more social connectedness during the pandemic and education accentuates the effects of forced isolation related to loneliness among urban African-American older adults.

A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study

BACKGROUND

Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available.

OBJECTIVE

This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement.

METHODS

An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network.

RESULTS

The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period.

CONCLUSIONS

A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network.

Factors Contributing to Well-Being in Japanese Community-Dwelling Older Adults Who Experienced Spousal Bereavement

PURPOSE

Providing support for older adults after spousal bereavement is crucial for psychological recovery through the grieving process and for promoting a healthy and happy remainder of life. The current study aimed to understand factors influencing well-being among Japanese community-dwelling older adults who experienced spousal bereavement by evaluating how their roles and activities affected their psychological well-being following the loss.

METHOD

We conducted a cross-sectional, anonymous, self-administered questionnaire survey of 332 older adults who had experienced death of a spouse in later adulthood.

RESULTS

Identified factors that affected well-being after spousal loss were sex, ability to go out without assistance from others, long duration since spousal loss, having a hobby, and adopting a life-oriented approach to cope with bereavement. Well-being following spousal loss was influenced by participants' activities and roles.

CONCLUSION

Findings of the current study provide potentially valuable suggestions for surviving spouses and their supporters when coping with grief following spousal loss. [Research in Gerontological Nursing, 17(3), 121-130.].

Prolonged grief disorder symptomology in three African countries: A network analysis and comparison

Background

Bereavement is a globally prevalent life stressor, but in some instances, it may be followed by a persistent condition of grief and distress, codified within the 11th edition of the International Classification of Diseases (ICD-11) as prolonged grief disorder (PGD). Network analysis provides a valuable framework for understanding psychological disorders at a nuanced symptom-based level.

Aim

This study novelly explores the network structure of ICD-11 PGD symptomology in a non-Western sample and assesses the replication of this across three African country sub-samples in these data.

Methodology

Network models were estimated using the "Inventory of Complicated Grief-Revised" in a sample of trauma-exposed individuals who experienced bereavement throughout life (N = 1,554) from three African countries (Ghana, n = 290; Kenya, n = 619; Nigeria, n = 645). These networks were statistically evaluated using the network comparison test.

Results

It was found that "Feelings of Loss" and "Difficulty moving on" were the most central symptoms in the combined sample network. These findings were largely consistent for the Ghana and Nigeria sub-samples, however, network structure differences were noted in the Kenya sub-sample.

Conclusion

The identified PGD network highlights particular indicators and associations across three African samples. Implications for the assessment and treatment of PGD in these cultural contexts warrant consideration.

Types of bereavement and depressive symptoms among older adults: Does race/ethnicity matter?

AIM

To explore racial/ethnic differences in relation between types of bereavement and depressive symptoms among older adults in the USA.

METHODS

The sample limited to racially/ethnically diverse adults aged ≥55 (n = 879) was drawn from the third wave of the National Social Life, Health, and Aging Project (NSHAP). The NSHAP provides self-identified racial/ethnic categories (non-Hispanic Whites, Blacks, and Hispanics) of respondents who were categorized into three groups by experience of bereavement: non-loss, spousal loss, and parental loss. Using the weights, a two-way analysis of covariance with Bonferroni post-test was conducted to explore the main effect of types of loss and race/ethnicity and their interaction effects on depressive symptoms.

RESULTS

Spousal loss reported higher levels of depressive symptoms than non-loss or parental loss. Based on the interaction between types of loss and race/ethnicity; however, distinctive patterns were observed. Blacks and Hispanics who lose a parent reported significantly higher levels of depressive symptoms than non-Hispanic Whites did.

CONCLUSIONS

An increase in depressive symptoms after bereavement manifested distinctively based on racial/ethnic background and the relationship with the deceased. This implies that it is necessary to develop coping strategies concerning race/ethnicity and whom they lose. Geriatr Gerontol Int 2024; 24: 266-272.

The Inventory of Social Expectations in Bereavement: Development and psychometric validation of a new instrument

Negative expectations concerning social interactions contribute to feelings of loneliness. Since loneliness is one of the most pronounced challenges for bereaved individuals, we investigated grief-specific social expectations and its association with loneliness and grief severity. Initially, we developed an Inventory of Social Expectations in Bereavement (ISEB). Its factorial and psychometric validity was then tested in a bereaved sample (N = 344; 28.3 ± 11.1 years; 74.4% female). A two-factor solution for the scale fit the data best (factor 1: "relationship to others," factor 2: "relationship to the deceased") and demonstrated good psychometric validity. Higher ISEB-levels were associated with higher levels in grief severity and loneliness. The results suggest that individual social expectations affect the experience of loneliness after the loss of a significant other. The ISEB assesses these expectations time-efficiently and provides a basis for therapeutic interventions. Expressing expectations as probabilistic beliefs about the future renders them amenable for corrective experiences in clinical practice.

A novel approach for constructing personalized networks from longitudinal perceived causal relations

Personalized networks of psychological symptoms aim to advance therapy by identifying treatment targets for specific patients. Statistical relations in such networks can be estimated from intensive longitudinal data, but their causal interpretation is limited by strong statistical assumptions. An alternative is to create networks from patient perceptions, which comes with other limitations such as retrospective bias. We introduce the Longitudinal Perceived Causal Problem Networks (L-PECAN) approach to address both these concerns. 20 participants screening positive for depression completed 4 weeks day of brief daily assessments of perceived symptom interactions. Quality criteria of this new method are introduced, answering questions such as "Which symptoms should be included in networks?", "How many datapoints need to be collected to achieve stable networks?", and "Does the network change over time?". Accordingly, about 40% of respondents achieved stable networks and only few respondents exhibited network structure that changed during the assessment period. The method was time-efficient (on average 7.4 min per day), and well received. Overall, L-PECAN addresses several of the prevailing issues found in statistical networks and therefore provides a clinically meaningful method for personalization.

Childhood Adversity and Emerging Psychotic Experiences: A Network Perspective

BACKGROUND AND HYPOTHESIS

Childhood adversity is associated with a myriad of psychiatric symptoms, including psychotic experiences (PEs), and with multiple psychological processes that may all mediate these associations.

STUDY DESIGN

Using a network approach, the present study examined the complex interactions between childhood adversity, PEs, other psychiatric symptoms, and multiple psychological mediators (ie, activity-related and social stress, negative affect, loneliness, threat anticipation, maladaptive cognitive emotion regulation, attachment insecurity) in a general population, adolescent sample (n = 865, age 12-20, 67% female).

STUDY RESULTS

Centrality analyses revealed a pivotal role of depression, anxiety, negative affect, and loneliness within the network and a bridging role of threat anticipation between childhood adversity and maladaptive cognitive emotion regulation. By constructing shortest path networks, we found multiple existing paths between different categories of childhood adversity and PEs, with symptoms of general psychopathology (ie, anxiety, hostility, and somatization) as the main connective component. Sensitivity analyses confirmed the robustness and stability of the networks. Longitudinal analysis in a subsample with Wave 2 data (n = 161) further found that variables with higher centrality (ie, depression, negative affect, and loneliness) better predicted follow-up PEs.

CONCLUSIONS

Pathways linking childhood adversity to PEs are complex, with multifaceted psychological and symptom-symptom interactions. They underscore the transdiagnostic, heterotypic nature of mental ill-health in young people experiencing PEs, in agreement with current clinical recommendations.

Serial multiple mediation of loneliness and depressive symptoms in the relationship between pain and cognitive function among older people

OBJECTIVES

Although the negative effect of pain on cognitive function has been widely reported, it is unclear how the effect is mediated. The aim of this study is to analyze the mediating role of loneliness and depressive symptoms in the association between pain and cognitive function.

METHODS

A total of 6,309 participants aged ≥50 years from 2012/13 (T1), 2014/15 (T2), 2016/17 (T3) and 2018/19 (T4) of the English Longitudinal Study of Aging (ELSA) were included. Of them, 55.8% were females, and the median age (rang) was 65 (50-99) years at T1. Serial mediation analysis was performed using Mplus 8.3.

RESULTS

The mediation model explained 10.1% of the variance in loneliness, 22.1% of the variance of depressive symptoms, and 22.7% of the variance of cognitive function. Higher level pain was associated with poorer cognitive function (c: β = -0.057; p < 0.001). The negative effect of pain on cognition was mediated separately and sequentially through loneliness and depressive symptoms, with loneliness and depressive symptoms explaining 8.8% of the total effect, respectively, and the pathway of loneliness and subsequent depression explaining 1.8%.

CONCLUSIONS

Diversified interventions aimed at treating pain in older adults would be beneficial for their mental health and cognitive function.

Depression and loneliness symptoms in Brazilian older people during the COVID-19 pandemic: a network approach

OBJECTIVES

Depression and loneliness in older people were a global challenge during the COVID-19 pandemic. Causal mechanisms to trigger depression might vary across different life events. We aimed to apply network analysis in a sample of Brazilian older people during the first wave of the COVID-19 pandemic, to investigate if loneliness and depression symptoms were connected within a psychological network. We explored how symptoms manifested and interacted, to discuss possible interventions that could mitigate late-life depression and loneliness symptoms in face of the COVID-19 pandemic.

METHOD

We collected data from 384 Brazilian older people who answered an online protocol to assess sociodemographic data, loneliness symptoms (assessed by the short version of UCLA-BR), and depression symptoms (assessed by the PHQ-2).

RESULTS

'Lack of companionship' was the bridge symptom connecting loneliness and depression communities. 'I feel shut out and excluded by others' and 'People are around me, but not with me' were the most predictable symptoms of loneliness.

CONCLUSION

Interventions aimed to promote older people's social participation and skills, combined with strategies to expand their sources of social support and combat ageism, might be relevant to mitigate symptoms of loneliness and depression in older people during a crisis like the COVID-19 pandemic.

The impact of childhood trauma on perceived stress and personality in patients with obsessive-compulsive disorder: A cross-sectional network analysis

OBJECTIVE

Little is known about the role of childhood experiences in the development of obsessive-compulsive disorder (OCD). However, the influence of childhood experiences on personality, behavior, and perceived stress may vary between OCD patients and healthy individuals. The objective of this study was to use network analysis to explore the relationship between childhood trauma, personality, perceived stress, and symptom dimensions, thus finding the difference between patients' and healthy people's network.

METHODS

488 patients with OCD and 210 healthy volunteers were recruited. All of them were assessed with the Obsessive-Compulsive Inventory - Revised (OCI-R), the Perceived Stress Scale-10, the NEO Five-Factor Inventory and the Early Trauma Inventory Self-Report Short Form. Network analysis was conducted and the centrality indices were calculated. Network comparison test was performed.

RESULTS

In patients' network, the Obsession and the Ordering behavior were the most important nodes among the OCI-R. The perceived stress showed the strongest strength centrality of all nodes and positive correlation with the Obsession and Neuroticism. Network comparison test results indicated a statistically significant difference between network structure, and post-hoc analysis found five edges significantly differed between patients and healthy controls, mainly on Obsession and Washing behaviors.

CONCLUSIONS

Emotional abuse was considered significant in both networks due to its higher strength centrality. Meanwhile, perceived stress was found to be more significant in the patient network and exhibited stronger associations with obsession. The obsessive thoughts and washing behavior were different among patients and healthy controls, which brought new understanding to the pathopsychological mechanisms of OCD.

Depression deconstructed: Wearables and passive digital phenotyping for analyzing individual symptoms

Wearable technology enables unobtrusive collection of longitudinally dense data, allowing for continuous monitoring of physiology and behavior. These digital phenotypes, or device-based indicators, are frequently leveraged to study depression. However, they are usually considered alongside questionnaire sum-scores which collapse the symptomatic gamut into a general representation of severity. To explore the contributions of passive sensing streams more precisely, associations of nine passive sensing-derived features with self-report responses to Center for Epidemiologic Studies Depression (CES-D) items were modeled. Using data from the NetHealth study on N=469 college students, this work generated mixed ordinal logistic regression models to summarize contributions of pulse, movement, and sleep data to depression symptom detection. Emphasizing the importance of the college context, wearable features displayed unique and complementary properties in their heterogeneously significant associations with CES-D items. This work provides conceptual and exploratory blueprints for a reductionist approach to modeling depression within passive sensing research.

Building an Early Warning System for Depression: Rationale, Objectives, and Methods of the WARN-D Study

Background

Depression is common, debilitating, often chronic, and affects young people disproportionately. Given that only 50% of patients improve under initial treatment, experts agree that prevention is the most effective way to change depression's global disease burden. The biggest barrier to successful prevention is to identify individuals at risk for depression in the near future. To close this gap, this protocol paper introduces the WARN-D study, our effort to build a personalized early warning system for depression.

Method

To develop the system, we follow around 2,000 students over 2 years. Stage 1 comprises an extensive baseline assessment in which we collect a broad set of predictors for depression. Stage 2 lasts 3 months and zooms into participants' daily experiences that may predict depression; we use smartwatches to collect digital phenotype data such as sleep and activity, and we use a smartphone app to query participants about their experiences 4 times a day and once every Sunday. In Stage 3, we follow participants for 21 months, assessing transdiagnostic outcomes (including stress, functional impairment, anxiety, and depression) as well as additional predictors for future depression every 3 months. Collected data will be utilized to build a personalized prediction model for depression onset.

Discussion

Overall, WARN-D will function similarly to a weather forecast, with the core difference that one can only seek shelter from a thunderstorm and clean up afterwards, while depression may be successfully prevented before it occurs.

The Trajectory of Depression through Disenfranchised Grief in Young Widows in Times of COVID-19: A Case Report from Rural India

The COVID-19 pandemic was one of this century's deadliest and most widespread viral outbreaks, with higher mortality rates in men than women. Disruptions in funeral rituals and customs, no social recognition of the losses, and limited social support have complicated the grieving process and are linked to disenfranchised (not openly acknowledged, socially recognized, or publicly mourned) grief. Depression is also highly comorbid with complicated grief. Losing a spouse can be devastating, and this is more severe for women with limited or no resources, who are vulnerable because of the patriarchal society. In the current COVID-19 era, increased uncertainty and disenfranchised grief can worsen the clinical scenario and hamper interventions, as highlighted by the present case report on disenfranchised grief with depressive symptoms in a 30-year-old woman from rural India who, after a year of marriage, lost her husband due to COVID-19. This case study emphasizes the impact of multiple types of disadvantages due to sociodemographic and cultural determinants that can complicate the grieving process in the current context. The bioecological model of grief recovery considers individual features and societal/environmental factors to postulate the appropriate intervention. Finding meaning and purpose in life and restoration-oriented coping were successful for the clinical management of the patient.

Network analysis of comorbid depression, suicidality and biomarkers on HPA axis among mood disorder patients to psychiatric emergency services

Rapid assessment and intervention of suicide risk are common and challenging in psychiatric emergency departments (PED). It is unclear whether distinct pathophysiological processes exist among depressive patients with suicidality. This study examined the network structures of biomarkers on Hypothalamic-Pituitary-Adrenal (HPA) axis, such as Adrenocorticotropic hormone (ACTH) and Corticosterone (Cort), as well as suicidality and depressive symptoms in mood disorder patients in PED. Mood disorder patients in PED were assessed with the measurements of suicidality and depressive symptoms, respectively. A network analysis was performed to identify central symptoms and bridge symptoms of this network and their links to ACTH and Cort. Network stability was examined using the case-dropping procedure. The Network Comparison Test (NCT) was conducted to evaluate whether network characteristics differed by gender. A total of 1815 mood disorder patients were recruited. The prevalence of SI was 31.2% (95% CI: 28.15-34.21%), SP was 30.4% (95% CI: 27.39-33.41%), SA was 30.62% (95% CI: 27.61-33.64%) among psychiatric outpatients. The mean score of HAMD-24 was 13.87 ± 8.02. Network analysis revealed that 'Somatic anxiety' had the highest expected centrality, followed by 'Hopelessness' and 'Suicide attempt'. 'Corticosterone' and 'Retardation' may be the main bridge symptoms between depressive symptoms and the suicidality community. The network model showed a high degree of stability. Gender did not significantly influence the network structure. The central symptoms and key bridge symptoms identified could be potential targets for interventions of the HPA axis, which is designed for regular screening of a range of suicidal activity. In the light of this, timely treatment should be provided for psychiatric emergency care.

Self-Compassion for Caregivers of Children in Parentally Bereaved Families: A Theoretical Model and Intervention Example

Family-based bereavement interventions have shown promises to prevent problem outcomes and promote resilience in parentally bereaved children. Evidence of the broad range of mental and physical health problems following the death of a parent supports the need for a transdiagnostic approach that promotes adaptation and reduces multiple problem outcomes for parentally bereaved families. We discuss self-compassion as a promising framework for a transdiagnostic approach. We argue that three elements of self-compassion-mindfulness (vs. over-identification), self-kindness (vs. self-judgment), and common humanity (vs. isolation)-can facilitate loss-oriented coping, restoration-oriented coping, and the oscillation process between the two. This sets the foundation for individual and family processes that support bereavement adjustment. To explain how self-compassion promotes adjustment outcomes in parentally bereaved families, we review the extant literature with a focus on parental emotion regulation and effective parenting and propose a conceptual model with testable hypotheses to guide more research in this area. The model suggests that caregivers' self-compassion is a resilience resource for multiple adaptive outcomes for themselves and for their child through its positive impacts on emotion regulation and effective parenting. We illustrate the utility of the framework with an example of a family-based bereavement prevention program that integrated self-compassion training. Future directions for research are discussed.

Social exclusion and critical transitions in later life: Trajectories, forms and mechanisms

Unequal ageing patterns are increasingly prevalent within the life courses of heterogeneous older populations. Critical transitions in later life may contribute to these patterns and to more multifaceted deep-rooted forms of social exclusion. Yet despite significant research in this area, knowledge gaps remain regarding the subjective experiences of these transitions, the trajectories and constituent events of these transitions, and the related mechanisms that may drive exclusion. With a focus on lived experience, this article aims to investigate the role of critical life transitions in older age in constructing multidimensional social exclusion. The onset of dementia, bereavement of a significant other, and forced migration are selected as three illustrative transitions in older age. Based on 39 in-depth life-course interviews and life-path analyses, the study sets out to illuminate common features of the transitional process that increases exclusion susceptibility, and the potential commonalities regarding transition-related exclusionary mechanisms. Transition trajectories related to each of the transitions are first described identifying shared exclusionary risk features. Transition-related mechanisms that can generate multidimensional social exclusion are then presented as arising from a transition's nature and character, its structural and management aspects, and its symbolic and normative positioning. Findings are discussed with reference to the international literature and future conceptualisation of social exclusion in later life.

Social network typologies moderate the association of loneliness with depressive symptomatology in middle-aged and older adults

Background

Depression remains among the most prevalent mental disorders, and it severely affects daily functioning and quality of life. There has been extensive research reporting on the impact of social relationships on depression, but much of this research has only considered isolated aspects of relationships. This study derived social network types based on the multiple components of social relationships, and then investigated their effects on depressive symptoms.

Methods

Using samples of 620 adults (M_age = 53.52), Latent Profile Analysis (LPA) was conducted to uncover network types based on the structural (network size, contact frequency, marital status, and social engagement), functional (levels of support and conflict), and qualitative (satisfaction with relationships) aspects of social relationships. Multiple regressions were used to test if distinct network types directly impact on depressive symptoms and whether network types moderate the association of loneliness (perceived social isolation) with depressive symptoms.

Results

LPA identified four distinct network types (diverse, family-focused, friend-focused, and restricted) and there were significant differences in depressive symptoms among four network types. Analysis using the BCH method showed that individuals in the restricted network type had the highest depressive symptoms, followed in order by individuals in the friend-focused, family-focused, and diverse network types. Regression results further indicated that an individual's network network type membership was significantly associated with depressive symptoms, and being in the diverse and family-focused network types alleviated the negative effect of loneliness on depressive symptoms.

Conclusion

The results suggest that both quantitative and qualitative aspects of social relationships are important in buffering against the adverse effect of loneliness on depressive symptoms. These findings underscore the utility of taking a multi-dimensional approach to uncover heterogeneity in the social networks of adults and their implications on depression.

Symptoms of internet gaming disorder and depression in Chinese adolescents: A network analysis

The current study aimed to investigate comorbidity among symptoms of depression and internet gaming disorder (IGD) utilizing symptom network analysis in a sample of Chinese adolescents. A total of 1,362 Chinese adolescents (Mean age = 15.19 ± 1.67; range 13-21; 39.79% female, 56.02% male, 4.19% not disclosed) were recruited from 11 local secondary schools between June and July 2020. Symptoms of depression and IGD were assessed by the 7-item DASS-21 depression subscale and the 9-item Internet Gaming Disorder Scale. We conducted network analysis to estimate network models and the most central symptoms of depression and IGD and computed a combined network model of both depression and IGD symptoms to find bridge symptoms and illustrate the comorbidity between depression and IGD. We found that feeling 'Worthless', 'Meaningless', and 'Down-hearted' were identified as the most central symptoms of depression, whereas 'Preoccupation' and 'Tolerance' were the two most central symptoms of IGD. The bridge symptoms in the combined network model were 'Gaming for escape or mood relief' from the IGD cluster and 'No initiative' and 'Down-hearted" from the depression cluster. The current study was the first to investigate the relationship between depression and IGD symptoms among adolescents utilizing a symptom network perspective. Also, it highlighted key bridge symptoms in understanding how IGD and depression contribute to each other.

Using network analysis to detect associations between suspected painful health conditions and behaviour in dogs

Pain associated with chronic health conditions in non-human animals is an important animal welfare issue. To identify animals in pain and develop an understanding of the mechanisms by which pain affects behaviour, it is therefore important to establish the direct behavioural effects of painful health conditions. We reanalyse data from a cross-sectional survey that considered the presence or absence of a painful condition in dogs and quantified their affective predispositions using the Positive and Negative Activation Scale (PANAS). By applying ideas from network theory, we conceptualise pain as a stressor that exerts direct effects on a network of interacting behavioural variables, and subsequently estimated a network model of conditional dependence relations. Painful health conditions were positively conditionally associated with age (posterior mean partial correlation, ρ = 0.34; standard deviation [SD]=0.05), and negatively conditionally associated with the item 'your dog is full of energy' (ρ = -0.14; SD=0.06). In turn, the energy item was conditionally associated with other PANAS items which were marginally associated with pain, such as items representing ease of excitability and persistence in play. This suggests these marginal effects might be indirectly mediated via the energy item. Further, utilising the posterior predictive distribution we estimated that the median conditional probability (95% credible interval) of a painful health condition given an answer of 'strongly agree' on the energy item was 0.08 (0.05, 0.11), which increased to 0.32 (0.09, 0.58), given a response of 'strongly disagree'. This provides a potentially clinically useful interpretation of the conditional dependencies detected in the network.

Why Does Grief Hurt?

Abstract. Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.

Associations Between Changes in Loneliness and Social Connections, and Mental Health During the COVID-19 Pandemic: The Women's Health Initiative

BACKGROUND

Older women have faced significant disruptions in social connections during the coronavirus disease 2019 pandemic. Whether loneliness increased or whether a change in loneliness from pre- to intrapandemic period was associated with mental health during the pandemic is unknown.

METHODS

Older women (n = 27 479; mean age 83.2 [SD: 5.4] years) completed surveys in mid-2020, including questions about loneliness, living arrangements, changes in social connections, and mental health. Loneliness was also previously assessed in 2014-2016. We examined whether loneliness changed from the pre- to intrapandemic period and explored factors associated with this change. In multivariable models, we investigated the association of changes in loneliness and social connections with mental health.

RESULTS

Loneliness increased from pre- to intrapandemic levels. Factors associated with worsening loneliness included older age, experiencing stressful life events, bereavement, histories of vascular disease and depression, and social connection disruptions. Factors associated with a decrease in loneliness included identifying as Black, engaging in more frequent physical activity, being optimistic, and having a higher purpose in life. A 3-point increase in loneliness scores was associated with higher perceived stress, higher depressive, and higher anxiety symptoms. Social connection disruptions showed modest or no associations with mental health.

CONCLUSIONS

Loneliness increased during the pandemic in older women and was associated with higher stress, depressive, and anxiety symptoms. Our findings point to opportunities for interventions targeting lifestyle behaviors, well-being, disrupted social connections, and paying closer attention to those with specific medical and mental health histories that may reduce loneliness and improve mental health.

Potential risk factors for acute grief during the COVID-19 pandemic: The mediating role of avoidance processes

Bereavement during the COVID-19 pandemic may have some unique characteristics that become potential risk factors (e.g., absence of grief rituals, no opportunity to say goodbye to the deceased and loneliness caused by social distancing) for acute grief. Avoidance processes could be significant mediators in the context of the pandemic. The current study aimed to investigate whether and how these COVID-19-related risk factors were related to acute grief severity. Bereaved adults (n = 319) who lost significant others during the COVID-19 pandemic completed a self-report questionnaire package measuring COVID-19-related factors, grief severity and depressive and anxious avoidance. Regression analyses suggested that among the three potential risk factors (loneliness, grief rituals and opportunity to say goodbye), loneliness was significantly associated with acute grief after controlling for basic demographic and loss-related information. Structural equation models suggested that depressive avoidance and anxious avoidance partially mediated the associations of loneliness with acute grief severity. The findings indicate that dealing with loss during the COVID-19 pandemic warrants further exploration concerning how potential environmental risk factors may impede adaptation to loss. Depressive and anxious avoidance processes may play important roles in grief interventions for isolated and lonely bereaved people.

Creativity and art therapies to promote healthy aging: A scoping review

The purpose of this scoping review is to investigate the value of creative arts therapies in healthy older adults. This article aims to shed light on current knowledge concerning the effectiveness of art therapies (ATs) for the prevention of common age-related conditions using the definition of art therapy provided by the American Art Therapy Association (AATA), as well as Cohen's conceptual framework for the psychological conceptualization of the relationship between the arts and health in later life. The objective is to carefully capture subthreshold situations of distress, which are often not taken into account and primarily involve psychological aspects that are crucial in the multidimensional perspective of healthy aging. Twelve articles were selected and examined following an initial electronic search on 3 databases. A thematic analysis of the results identified four major themes: improving cognitive performance and proprioception; enhancing self-identity and meaningful life; reducing feelings of loneliness and depressive symptoms; and the importance of socialization. All these aspects constitute the basis for preventing psychological distress and enhancing mental well-being for healthy aging.

Bereavement and Prognosis After a First Acute Myocardial Infarction: A Swedish Register-Based Cohort Study

BACKGROUND Despite accumulating evidence suggesting that bereavement is associated with increased risks of cardiovascular morbidity and mortality, the association between bereavement and prognosis after acute myocardial infarction (AMI) has not been well documented. We investigated the association by using Swedish register data. METHODS AND RESULTS We studied 266 651 patients with a first AMI included in the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) quality register from 1991 to 2018. We obtained information on bereavement (ie, death of a partner, child, grandchild, sibling, or parent), on primary (nonfatal recurrent AMI and death attributed to ischemic heart disease) and secondary outcomes (total mortality, heart failure, and stroke) and on covariates from several national registers. The association was analyzed using Poisson regression. The bereaved patients had a slightly increased risk of the primary outcome; the corresponding risk ratio (RR) was 1.02 (95% CI, 1.00-1.04). An increased risk was noted any time bereavement occurred, except if the loss was in the year after the first AMI. The association was strongest for the loss of a partner, followed by the loss of a child, grandchild, sibling, or parent. We also observed increased risks for total mortality (RR, 1.14 [95% CI, 1.12-1.16]), heart failure (RR, 1.05 [95% CI, 1.02-1.08]), and stroke (RR, 1.09 [95% CI, 1.05-1.13]) following bereavement. CONCLUSIONS Bereavement was associated with an increased risk of poor prognosis after a first AMI. The association varied by the relationship to the deceased.

An evolutionary investigation of depressed mood: The relationship between daily stressors and patterns of depressive symptoms

BACKGROUND AND OBJECTIVES

The situation-symptom congruence hypothesis (SSCH; (Keller & Nesse, 2006), grounded in evolutionary theory, argues that different types of adversity should lead to distinct patterns of depressive symptoms that help individuals deal with adaptive challenges. Situation-symptom congruence hypotheses were tested in this study using experience sampling methodology.

METHODS

Two hundred and sixty-five individuals, including 54% who scored at least 16 on the Center for Epidemiologic Studies Revised Depression Scale, responded to text prompts daily for up to 9 days, reporting depressive symptoms as well as the most stressful event or issue they had experienced or focused on within the past 24 h.

RESULTS

Multilevel modeling analyses indicated that the relationships between stressors and depressive symptom patterns were largely consistent with SSCH predictions. All stressors were significantly associated with symptoms hypothesized to be adaptive in response to those stressors. Moreover, in separate analyses, nine of the ten symptoms examined were either predicted by the stressors hypothesized to lead to that symptom or negatively related to stressors hypothesized to not elicit those symptoms.

LIMITATIONS

It is unclear whether the results generalize to those diagnosed with a major depressive disorder; the study did not assess actual life events.

CONCLUSIONS

Findings suggest that depressive symptoms may, in part, be adaptations that have evolved through natural selection to help individuals cope with adverse situations.

Revisiting the theoretical and methodological foundations of depression measurement

Depressive disorders are among the leading causes of global disease burden, but there has been limited progress in understanding the causes and treatments for these disorders. In this Perspective, we suggest that such progress crucially depends on our ability to measure depression. We review the many problems with depression measurement, including limited evidence of validity and reliability. These issues raise grave concerns about common uses of depression measures, such as diagnosis or tracking treatment progress. We argue that shortcomings arise because depression measurement rests on shaky methodological and theoretical foundations. Moving forward, we need to break with the field's tradition that has, for decades, divorced theories about depression from how we measure it. Instead, we suggest that epistemic iteration, an iterative exchange between theory and measurement, provides a crucial avenue for depression measurement to progress.

Anxiety and Depression in a Non-Clinical Sample of Young Polish Adults: Presence of Meaning in Life as a Mediator

Early adulthood, between 18 and 25, is viewed as a decisive period of life for the prevention and treatment of anxiety and depression. Although the topic of their mutual relationship is well-known, little has been uncovered about the mechanism underlying this connection. To understand the indirect pathways between anxiety and depression, we chose the sense of meaning of life as a mediator because people's beliefs that their lives are or can be purposeful may protect against depression. The sample was composed of 277 Polish young adults. A small majority of the participants were women (58.8%). The mean age was M = 22.11 (SD = 1.72). We used in the research the Direct Behavior Rating-Scale Items Scale, the Meaning in Life Questionnaire, and the Brief Screen for Depression. Correlational analysis showed that, consistent with past findings, anxiety correlated positively with depression and searching for meaning. It was also negatively associated with presence of meaning. Moreover, depression was negatively linked to presence of meaning and positively with searching for meaning. Regression-based mediation analyses (PROCESS macro 3.4) proved that the relationship between anxiety and depression was mediated by presence of meaning in life, suggesting that having a sense of meaning may be a pathway by which feelings of tension relative to adverse events protect against depression.

Coexisting service-related factors preceding suicide: a network analysis

OBJECTIVES

The overall objective was to analyse service-related factors involved in the complex processes that precede suicide in order to identify potential targets for intervention.

DESIGN AND SETTING

Explorative network analysis study of post-suicide root cause analysis data from Swedish primary and secondary healthcare.

PARTICIPANTS

217 suicide cases reported to the Swedish national root cause analysis database between 2012 and 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

A total of 961 reported incidents were included. Demographic data and frequencies of reported deficiencies were registered. Topology, centrality indices and communities were explored for three networks. All networks have been tested for robustness and accuracy.

RESULTS

Lack of follow-up, evaluations and insufficient documentation issues emerged as central in the network of major themes, as did the contributing factors representing organisational problems, failing procedures and miscommunication. When analysing the subthemes of deficiencies more closely, disrupted treatments and staffing issues emerged as prominent features. The network covering the subthemes of contributing factors also highlighted discontinuity, fragile work structures, inadequate routines, and lack of resources and relevant competence as potential triggers. However, as the correlation stability coefficients for this network were low, the results need further investigation. Four communities were detected covering nodes for follow-up, evaluation, cooperation, and procedures; communication, documentation and organisation; assessments of suicide risk and psychiatric status; and staffing, missed appointments and declined treatment.

CONCLUSION

The results of this study suggest that healthcare providers may improve patient safety in suicide preventive pathways by taking active measures to provide regular follow-ups to patients with elevated suicide risk. In some cases, declined or cancelled appointments could be a warning sign. Tentative results show organisational instability, in terms of work structure, resources and staffing, as a potential target for intervention, although this must be more extensively explored in the future.

Network analyses of Oppositional Defiant Disorder (ODD) symptoms in children

Based on parent and teacher ratings of their children, this study used regularized partial correlation network analysis (EBIC glasso) to examine the structure of DSM-5 Oppositional Defiant Disorder (ODD) symptoms. Parent and teachers (N = 934) from the general community in Malaysia completed questionnaires covering DSM-5 ODD symptoms. The most central ODD symptom for parent ratings was anger, followed by argue. For teacher ratings, it was anger, followed by defy. For both parent and teacher ratings, the networks revealed at least medium effect size connections for temper and argue, defy, and argue, blames others, and annoy, and spiteful and angry. Overall, the findings were highly comparable across parent and teacher ratings, and they showed a novel understanding of the structure of the ODD symptoms. The clinical implications of the findings for assessment and treatment of ODD are discussed.

Neurobiology of Loneliness, Isolation, and Loss: Integrating Human and Animal Perspectives

In social species such as humans, non-human primates, and even many rodent species, social interaction and the maintenance of social bonds are necessary for mental and physical health and wellbeing. In humans, perceived isolation, or loneliness, is not only characterized by physical isolation from peers or loved ones, but also involves negative perceptions about social interactions and connectedness that reinforce the feelings of isolation and anxiety. As a complex behavioral state, it is no surprise that loneliness and isolation are associated with dysfunction within the ventral striatum and the limbic system - brain regions that regulate motivation and stress responsiveness, respectively. Accompanying these neural changes are physiological symptoms such as increased plasma and urinary cortisol levels and an increase in stress responsivity. Although studies using animal models are not perfectly analogous to the uniquely human state of loneliness, studies on the effects of social isolation in animals have observed similar physiological symptoms such as increased corticosterone, the rodent analog to human cortisol, and also display altered motivation, increased stress responsiveness, and dysregulation of the mesocortical dopamine and limbic systems. This review will discuss behavioral and neuropsychological components of loneliness in humans, social isolation in rodent models, and the neurochemical regulators of these behavioral phenotypes with a neuroanatomical focus on the corticostriatal and limbic systems. We will also discuss social loss as a unique form of social isolation, and the consequences of bond disruption on stress-related behavior and neurophysiology.

Estimating Finite Mixtures of Ordinal Graphical Models

Graphical models have received an increasing amount of attention in network psychometrics as a promising probabilistic approach to study the conditional relations among variables using graph theory. Despite recent advances, existing methods on graphical models usually assume a homogeneous population and focus on binary or continuous variables. However, ordinal variables are very popular in many areas of psychological science, and the population often consists of several different groups based on the heterogeneity in ordinal data. Driven by these needs, we introduce the finite mixture of ordinal graphical models to effectively study the heterogeneous conditional dependence relationships of ordinal data. We develop a penalized likelihood approach for model estimation, and design a generalized expectation-maximization (EM) algorithm to solve the significant computational challenges. We examine the performance of the proposed method and algorithm in simulation studies. Moreover, we demonstrate the potential usefulness of the proposed method in psychological science through a real application concerning the interests and attitudes related to fan avidity for students in a large public university in the United States.

Resilience among bereaved college students: Indicators, facilitators, and barriers

We adopted a resilience framework to gain a deeper understanding of the specific ways that grief impacts college students and identify specific ways that counselors can promote resilience among this population. Data from interviews with 10 college students were analyzed using grounded theory. Three categories of themes related to promoting resilience among bereaved college students were extracted: indications of what needs to change to be doing OK, factors that facilitate becoming OK, and barriers to the grieving process and becoming OK. The facilitators for and barriers to achieving these indicators of resilience are discussed in the context of navigating bereavement as a college student. Specific recommendations are made for counselors and college personnel.

Modeling alcohol use disorder as a set of interconnected symptoms - Assessing differences between clinical and population samples and across external factors

Alcohol use disorder is argued to be a highly complex disorder influenced by a multitude of factors on different levels. Common research approaches fail to capture this breadth of interconnecting symptoms. To address this gap in theoretical assumptions and methodological approaches, we used a network analysis to assess the interplay of alcohol use disorder symptoms. We applied the exploratory analysis to two US-datasets, a population sample with 23,591 individuals and a clinical sample with 483 individuals seeking treatment for alcohol use disorder. Using a Bayesian framework, we first investigated differences between the clinical and population sample looking at the symptom interactions and underlying structure space. In the population sample the time spent drinking alcohol was most strongly connected, whereas in the clinical sample loss of control showed most connections. Furthermore, the clinical sample demonstrated less connections, however, estimates were too unstable to conclude the sparsity of the network. Second, for the population sample we assessed whether the network was measurement invariant across external factors like age, gender, ethnicity and income. The network differed across all factors, especially for age subgroups, indicating that subgroup specific networks should be considered when deriving implications for theory building or intervention planning. Our findings corroborate known theories of alcohol use disorder stating loss of control as a central symptom in alcohol dependent individuals.