Validation of a Brief Measure of Aggression for Ecological Momentary Assessment Research: The Aggression-ES-A

Translating the Transdiagnostic: Aligning Assessment Practices With Research Advances

Researchers and clinicians working within the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Rev (DSM-5-TR) framework face a difficult question: what does it mean to have an evidence-based assessment of a nonevidence-based diagnostic construct? Alternative nosological approaches conceptualize psychopathology as (a) hierarchical, allowing researchers to move between levels of description and (b) dimensional, eliminating artificial dichotomies between disorders and the dichotomy between mental illness and mental well-being. In this article, we provide an overview of ongoing efforts to develop validated measures of transdiagnostic nosologies (i.e., the Hierarchical Taxonomy of Psychopathology; HiTOP) with applications for measurement-based care. However, descriptive models like HiTOP, which summarize patterns of covariation among psychopathology symptoms, do not address dynamic processes underlying the problems associated with psychopathology. Ambulatory assessment, well-suited to examine such dynamic processes, has also developed rapidly in recent decades. Thus, the goal of the current article is twofold. First, we provide a brief overview of developments in constructing valid measures of the HiTOP model as well as developments in ambulatory assessment practices. Second, we outline how these parallel developments can be integrated to advance measurement-based treatment. We end with a discussion of some major challenges for future research to address to integrate advances more fully in transdiagnostic and ambulatory assessment practices.

Respondent characteristics associated with adherence in a general population ecological momentary assessment study

OBJECTIVES

Ecological momentary assessment (EMA) has seen an explosion in popularity in recent years; however, an improved understanding of how to minimise (selective) non-adherence is needed.

METHODS

We examined a range of respondent characteristics predictors of adherence (defined as the number of EMA surveys completed) in the D2M EMA study. Participants were a sample of n = 255 individuals drawn from the longitudinal z-proso cohort who completed up to 4 EMA surveys per day for a period of 2 weeks.

RESULTS

In unadjusted analyses, lower moral shame, lower self-control, lower levels of self-injury, and higher levels of aggression, tobacco use, psychopathy, and delinquency were associated with lower adherence. In fully adjusted analyses with predictors selected using lasso, only alcohol use was related to adherence: beer and alcopops to higher adherence and spirits to lower adherence.

CONCLUSIONS

These findings provide potential insights into some of the psychological mechanisms that may underlie adherence in EMA. They also point to respondent characteristics for which additional or tailored efforts may be needed to promote adherence.

Development of the item pool for the 'WHO-ageism scale': conceptualisation, item generation and content validity assessment

OBJECTIVES

ageism harms individuals' health and wellbeing and can be costly to societies. Reliable and valid measures that can quantify ageism are critical for achieving accurate data on its global prevalence, determinants and impacts, and to evaluate the effectiveness of interventions to reduce it. Ageism scales exist; however, none have been demonstrated to validly measure ageism in a manner consistent with consensus definitions of the concept (i.e. as manifested in all of stereotypes, prejudices and discrimination), whilst also quantifying ageism against all groups, from a target and perpetrator perspective, and across diverse country settings. Our objective was to develop an item pool to meet this need.

METHODS

we completed the conceptualisation, item generation and content validity assessment phases of a new World Health Organisation (WHO) WHO-ageism item pool that aims to measure the multi-dimensional nature of ageism. These phases drew on a review of available evidence, an experts' workshop and structured content validity reviews conducted by experts in scale development and ageism drawn from every world region defined by WHO.

RESULTS

our resulting item pool is designed to provide a multi-dimensional measure of ageism against all ages measured from both a perpetration and experienced perspective and that can produce valid and reliable scores within diverse country contexts and comparable scores across these contexts.

CONCLUSIONS

our item pool is the first major step in providing a global and comprehensive measure of ageism. Future phases of research will refine the item pool and establish the statistical psychometric properties of the final tool.

Psychometric evaluation of an adapted version of the perceived stress scale for ecological momentary assessment research

Ecological momentary assessment (EMA) methodologies are commonly used to illuminate the predictors and impacts of experiencing subjective stress in the course of daily life. The validity of inferences from this research is contingent on the availability of measures of perceived momentary stress that can provide valid and reliable momentary stress scores. However, studies of the development and validation of such measures have been lacking. In this study, we use an EMA data collection design to examine the within- and between- person reliability and criterion validity and between-person gender measurement invariance of a brief EMA-adapted measure of a widely used trait measure of stress: the Perceived Stress Scale (PSS). Scores showed high internal consistency reliability and significant correlations with a range of criterion validity measures at both the within- and between-person level. Gender measurement invariance up to the scalar level also held for scores. Findings support the use of the EMA-adapted PSS presented in the current study for use in community-ascertained samples to address research questions relating to the influences on and effects of momentary stress and their gender differences.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study

INTRODUCTION

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need.

METHODS AND ANALYSES

In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD.

ETHICS AND DISSEMINATION

This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

Ecological momentary assessment of mood regulation eating expectancies in eating disorders: Convergent and predictive validity

OBJECTIVE

Eating expectancies (EE) are the anticipation of various benefits or detriments from eating, with mood regulation being a salient type of EE associated with eating disorders. This study examined the convergent and predictive validity of ecological momentary assessment (EMA) mood regulation EE items, including mood improvement and mood worsening EE.

METHODS

Thirty women with binge-eating pathology completed a 14-day EMA protocol, which included measures of mood regulation EE, affect, appetite, appearance- and body-related factors and disordered-eating behaviours.

RESULTS

Greater within-subjects hunger and lower within-subjects positive affect and fullness were related to elevated mood improvement EE. Higher within-subjects appearance concerns, fullness, body social comparisons and thinness pressure were associated with higher mood worsening EE. Greater within-subjects mood worsening EE predicted greater likelihood of vomiting at the subsequent time point, but there were no within-subjects associations between mood improvement EE and behaviours. Yet, greater between-subjects mood worsening EE were associated with more restraint/restriction and binge eating, and greater between-subjects mood improvement EE were associated with more binge eating.

CONCLUSIONS

Findings support the convergent validity of EMA mood regulation EE items. There was limited predictive validity evidence, suggesting complexities in how mood regulation EE predict behaviour in daily life.

Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study

BACKGROUND

Ecological momentary assessment (EMA) is widely used in health research to capture individuals' experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies.

OBJECTIVE

This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation.

METHODS

We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents' characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study.

RESULTS

In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57.

CONCLUSIONS

Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health.

The Relative Importance of Psychopathy Features as Predictors of Externalizing Behaviors in Youth: A Multimethod Examination

Research in youth psychopathy has focused heavily on the affective features (i.e., callous-unemotional [CU] traits) given robust links to severe and chronic forms of externalizing behaviors. Recently, there have been calls to expand the scope of work in this area to examine the importance of other interpersonal (i.e., antagonism) and behavioral (i.e., disinhibition) features of psychopathy. In the present study, we apply an under-utilized statistical approach (i.e., dominance analysis) to assess the relative importance of CU traits, antagonism, and disinhibition in the prediction of externalizing behaviors in youth, cross-sectionally and at 9-month follow-up. Using a multi-informant (youth- and parent-report), multi-method (questionnaire, ecological momentary assessment [EMA]) preregistered approach in a diverse sample of clinically referred youth (Mage = 12.60 years, SD = .95 years, 47% female; 61% racial/ethnic minority), we found youth- and parent-reported psychopathy features accounted for a significant proportion of variance in externalizing behavior cross-sectionally and longitudinally. However, results provided limited support for our preregistered hypotheses. While antagonism and disinhibition had larger general dominance weights relative to CU traits for both youth- and parent-report, most differences were non-significant. Thus, the interpersonal, affective, and behavioral psychopathy features could not be distinguished from one another in terms of their importance in the prediction of externalizing behavior, assessed cross-sectionally or longitudinally. Taken together, the results highlight promising avenues for future research on the relative importance of youth psychopathy features.

Physiological reactions to acute stressors and subjective stress during daily life: A systematic review on ecological momentary assessment (EMA) studies

OBJECTIVE

This review aims to provide an overview of ecological momentary assessment (EMA) studies analyzing stress reactivity during daily life in terms of direct and moderated influence of acute stress on physiological responses.

MATERIALS AND METHODS

A systematic literature search was performed on November 29, 2021 using Web of Science, MEDLINE and PsycINFO to identify prospective EMA studies targeting acute stressors or stress under naturalistic conditions, without restrictions of publication date or population. Study quality was assessed for multiple EMA-specific sources of bias.

RESULTS

Out of 4285 non-duplicate records, 107 publications involving 104 unique studies were included. The majority of studies assessed acute physiological stress responses primarily through salivary cortisol (n = 59) and cardiovascular outcomes (n = 32). Most studies performed at least three measurements per day (n = 59), and had a moderate risk of recall bias (n = 68) and confounding (n = 85). Fifty-four studies reported a compliance of ≥80%. Direct, non-moderated positive associations were observed between acute stress exposure and concurrent cortisol levels (44%, n = 11/25), systolic (44%, 8/18) and diastolic blood pressure (53%, 8/15) and heart rate (53%, 9/17). Several inter- and intra-individual moderators were identified, such as age, gender, health status, chronic stress, work-related resources, physical activity and stress coping indicators.

CONCLUSIONS

About half of the reviewed EMA studies demonstrated direct associations between everyday acute stress exposure and physiological responses, including increased cortisol levels, blood pressure and heart rate. Results further suggested various moderator variables that could help develop tailored prevention strategies and identify groups at higher risk for dysfunctional stress responses.

REGISTRATION

PROSPERO-Reg.-No.: PROSPERO 2020 CRD42020163178.

Cohort Profile: The Zurich Project on the Social Development from Childhood to Adulthood (z-proso)

The Zurich Project on the Social Development from Childhood to Adulthood (z-proso) began in 2004 in response to the need for a better evidence base to support optimal child social development and prevent crime and violence. Since then, the study has tracked the development of a diverse sample of youths (N = 1,675 in the target sample; ~50% female) from age 7 (n = 1,360) to age 20 (n = 1,180), with primary data collection waves at ages 7, 8, 9, 10, 11, 12, 13, 15, 17, and 20. The study uses a multi-method, multi-informant design that combines teacher, youth, and parent reports with observational and behavioural measures, biosampling, functional imaging, and ecological momentary assessment. Analyses of the data have contributed important evidence to a diversity of topics in child and adolescent development, illuminating the developmental roots of crime and aggression, the impacts of exposure to different forms and combinations of victimisation, and trajectories of mental health and neurodevelopmental symptoms.

The gender symmetry problem in physical teen dating violence: A commentary and suggestions for a research agenda

Dating violence is a serious manifestation of harmful behaviour during adolescence. During the past decades, considerable research has shed light on patterns, causes, and consequences of dating violence. One of the most notable findings emerging from widely used survey instruments is that female adolescents report perpetrating physical dating violence more or equally frequently as male adolescents. Similarly, male youth appear to equally frequently report that they have been victims of physical dating violence as female adolescents. This commentary reviews issues emerging from the debate on gender symmetry in dating violence and proposes directions for future research. It suggests that future research needs to consider three interrelated issues to advance the field, namely: to improve the understanding of differences in harm, advance the knowledge of gender differences in the short-term dynamics involved in conflict and aggression, and strengthen the evidence base on shared and gender-specific developmental aetiologies of dating violence.

The association of polyvictimization with violent ideations in late adolescence and early adulthood: A longitudinal study

Violent ideations are increasingly recognized as an important psychological predictor for aggressive and violent behavior. However, little is known about the processes that contribute to violent ideations. This paper examines the extent to which polyvictimization triggers violent ideations in late adolescence and early adulthood, while also adjusting for dispositional and situational factors as well as prior violent ideations. Data came from three waves of the Zurich Project on the Social Development from Childhood into Adulthood (z-proso; n = 1465). Full-information maximum likelihood Tobit models were fitted to regress violent ideations experienced at ages 17 and 20 on multiple victimization experiences in the preceding 12 months while controlling for antecedent developmental risk factors and prior violent ideations. The results showed that violent ideations in late adolescence and early adulthood are influenced by violent thoughts, aggressive behavior, violent media consumption, moral neutralization of violence, and internalizing symptoms measured 2 years earlier. Experiences of polyvictimization significantly contributed to an increase in violent ideations both during late adolescence and in early adulthood. The exposure-response relationship between victimization and violent ideations did not significantly differ by sex. The findings are consistent with the notion that violent ideations are triggered by a retaliation-linked psychological mechanism that entails playing out other directed imaginary aggressive scenarios specifically in response to experiencing intentional harm-doing by others.

Intolerance of uncertainty, rumination, post-traumatic stress symptoms and aggression during COVID-19: a serial mediation model

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic can be identified as a source of traumatic stress. Previous studies have shown that post-traumatic stress and intolerance of uncertainty are associated with aggressive behaviour.

OBJECTIVE

In the present study, we aimed to test a serial mediation model, considering rumination and post-traumatic stress symptoms (PTSS) as mediators that link intolerance of uncertainty and aggression, while controlling the confounding effect of crisis-induced health and socioeconomic stressors during the COVID-19 pandemic.

METHOD

A total of 714 participants [533 (74.6%) females, 176 (24.7%) males, aged 18-64 years (M _age = 25.16, SD _age = 9.34)] completed the following self-reported scales: Aggression Scale, COVID-19 stressors checklist, Short Version of the Intolerance of Uncertainty Scale, Impact of Event Scale with Modifications for COVID-19, and Ruminative Thought Style Questionnaire.

RESULTS

The results revealed that there was an association between intolerance of uncertainty and aggressive behaviours. Moreover, the results of serial mediation analysis showed that intolerance of uncertainty predicts aggressive behaviours via rumination and PTSS. Besides, socioeconomic stressors are significantly associated with the level of PTSS and aggression, while health stressors are not significantly association with the level of PTSS and aggression.

CONCLUSIONS

The findings provide several contributions to understand the link between intolerance of uncertainty and aggressive behaviours during the COVID-19 pandemic, and confirm the importance of early psychological intervention, especially for those who are more likely to ruminate and suffer from PTSS, to prevent aggression and violence in the long run. In addition to health-related regulations, it is important to take the social and economic aspects of the crisis into account and develop intervention strategies accordingly. Nevertheless, the limitations of cross-sectional mediation analysis in explaining causal relationships should be kept in mind, and future studies should extend these findings using longitudinal data.