The use and reporting of cluster analysis in health psychology: a review

Coping with provoked vestibulodynia in a relational context-A cluster analysis of coping patterns and their associations with relational cognitions and goals

BACKGROUND

Provoked vestibulodynia (PVD) is a common pain condition, negatively impacting the relationships and sexual lives of sufferers. Women's coping behaviour has been associated with psychosexual outcomes, yet coping patterns in clinical PVD samples are unexplored, and it is not known how women's coping relates to their relational context.

METHOD

Women (N = 128) with PVD answered questionnaires about psychosexual function, pain coping (avoidance and endurance), relational- and pain catastrophizing, sexual goals and perceived partner responses. Cluster analysis was used to explore coping patterns; clusters were validated on measures of pain and psychosexual function and compared on catastrophizing, sexual goals and partner responses using multivariate analyses of variance.

RESULTS

The analysis yielded four clusters: endurance; combined high avoidance and endurance; avoidance; and combined low. The group with high levels of both avoidance and endurance coping displayed the worst psychosexual outcomes and high levels of pain- and relational catastrophizing, approach and avoidance goals and perceived negative partner responses.

CONCLUSION

There are distinct patterns of coping among women with PVD, and these coping patterns are associated with psychosexual outcomes and relational cognitions and goals, and perceived partner responses. Women who alternate between avoidance and endurance are more distressed and report worse psychosexual functioning. This pattern needs to be identified and addressed in the treatment of PVD.

SIGNIFICANCE STATEMENT

This study extends previous findings on vulvar pain coping patterns to a clinical population of women with PVD. It is further the first study to address the relationship between relational variables, such as partner responses and relational catastrophizing and different coping patterns. Thus, the contribution of this study is the contextualizing of coping patterns among women with PVD. The results showed that a combined pattern of avoidance and endurance coping is associated with high distress, poor psychosexual outcomes, and indications of insufficient relational coping, highlighting the need for clinical assessment and intervention to target both women's individual coping patterns and their relational context.

The Association Between Stuttering Burden and Psychosocial Aspects of Life in Adults

PURPOSE

Stuttering is a speech condition that can have a major impact on a person's quality of life. This descriptive study aimed to identify subgroups of people who stutter (PWS) based on stuttering burden and to investigate differences between these subgroups on psychosocial aspects of life.

METHOD

The study included 618 adult participants who stutter. They completed a detailed survey examining stuttering symptomatology, impact of stuttering on anxiety, education and employment, experience of stuttering, and levels of depression, anxiety, and stress. A two-step cluster analytic procedure was performed to identify subgroups of PWS, based on self-report of stuttering frequency, severity, affect, and anxiety, four measures that together inform about stuttering burden.

RESULTS

We identified a high- (n = 230) and a low-burden subgroup (n = 372). The high-burden subgroup reported a significantly higher impact of stuttering on education and employment, and higher levels of general depression, anxiety, stress, and overall impact of stuttering. These participants also reported that they trialed more different stuttering therapies than those with lower burden.

CONCLUSIONS

Our results emphasize the need to be attentive to the diverse experiences and needs of PWS, rather than treating them as a homogeneous group. Our findings also stress the importance of personalized therapeutic strategies for individuals with stuttering, considering all aspects that could influence their stuttering burden. People with high-burden stuttering might, for example, have a higher need for psychological therapy to reduce stuttering-related anxiety. People with less emotional reactions but severe speech distortions may also have a moderate to high burden, but they may have a higher need for speech techniques to communicate with more ease. Future research should give more insights into the therapeutic needs of people highly burdened by their stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25582980.

Heterogeneity of health-related quality of life after mild traumatic brain injury with systemic injury: a cluster analytic approach

PURPOSE

Health-related quality of life (HRQoL) is a key component of evaluating outcome after mild traumatic brain injury (mTBI). As outcome is heterogeneous following mTBI, it is relevant to examine individual differences in HRQoL. This study investigated whether multiple homogenous subgroups could be meaningfully identified, 10 weeks after hospitalised mTBI with systemic injury, on the basis of HRQoL profiles.

METHODS

Ninety-one adults were assessed for HRQoL, pain, fatigue, sleep quality, psychological distress, cognition and post-concussion symptoms.

RESULTS

Cluster analyses revealed three separate subgroups based on physical, mental, social and energy HRQoL. One group (42%) demonstrated normative levels of HRQoL on all subdomains. The remaining two groups demonstrated significantly reduced HRQoL on all subdomains. These groups had equivalently poor mental, social and energy HRQoL, but the smallest group (27%) had significantly poorer physical HRQoL. Multinomial logistic regression revealed that pain significantly and independently predicted group membership for the particularly poor physical HRQoL group. Fatigue was the only significant independent predictor of group membership for the remaining group with reduced HRQoL.

CONCLUSION

These findings suggest more than 50% of hospitalised individuals with mTBI and systemic injury, have reduced HRQoL, 10 weeks after mTBI. Pain and fatigue warrant clinical attention in these individuals.IMPLICATIONS FOR REHABILITATIONMild traumatic brain injury is a common event that has been shown to be associated with persistently reduced health-related quality of life in approximately 50% of individuals 6 to 12 months after injury.Health-related quality of life likely varies between individuals after injuryRelative to the "normal" population, most individuals in this cohort of individuals with mTBI and systemic injury had reduced mental, social and energy quality of life 10 weeks after injury.Fatigue and pain are important factors in reduced health-related quality of life after mTBI with systemic injury.Further research is needed to determine whether these fatigue and pain issues are related to mTBI-factors, such as headache, and/or related to systemic injury factors, which are common in the mTBI population.

Distinct profiles of mental health need and high need overall among New Zealand adolescents - Cluster analysis of population survey data

OBJECTIVE

The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students.

METHODS

We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey (n = 7721, ages 13-18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples.

RESULTS

We identified five clusters (n = 7083). The healthy cluster (n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster (n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster (n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster (n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster (n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Māori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity.

CONCLUSION

We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not 'one size fits all'. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster.

Identification of subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation

PURPOSE

To identify subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation, and to investigate whether training outcomes varied between subgroups.

MATERIALS AND METHODS

Data from a multicentre cohort study were used, involving participants following prehabilitation before oesophagectomy. Hierarchical cluster analysis was performed using four cluster variables (intensity of aerobic exercise, the Borg score during resistance exercise, intensity of physical activity, and degree of fatigue). Aerobic capacity and muscle strength were estimated before and after prehabilitation.

RESULTS

In 64 participants, three clusters were identified based on exercise intensity. Cluster 1 (n = 23) was characterised by fatigue and physical inactivity, cluster 2 (n = 9) by a low training capacity, despite high physical activity levels, and cluster 3 (n = 32) by a high training capacity. Cluster 1 showed the greatest improvement in aerobic capacity (p = 0.37) and hand grip strength (p = 0.03) during prehabilitation compared with other clusters.

CONCLUSIONS

This cluster analysis identified three subgroups with distinct patterns in exercise intensity during prehabilitation. Participants who were physically fit were able to train at high intensity. Fatigued participants trained at lower intensity but showed the greatest improvement. A small group of participants, despite being physically active, had a low training capacity and could be considered frail.

Problematic mobile phone use as impulsive choice: Development and empirical verification of a reinforcer-pathology model

Problematic mobile phone use is characterized by its "impulsive" nature; users engage in it despite their negative attitude toward it. From a behavioral-economic perspective, this attitude-behavior discrepancy is generated by competing contingencies that involve smaller-sooner social reinforcers associated with mobile phone use and larger-later prosocial reinforcers potentially compromised by phone use. Based on this conceptualization, the reinforcer-pathology model of problematic mobile phone use is proposed, which posits that such phone use stems from excessive delay discounting of the social and prosocial reinforcers and/or excessive demand for the social reinforcers. A secondary data analysis of previously published studies was conducted, with the novel addition of principal component analysis and hierarchical cluster analysis of these data. The results generated evidence that supports the reinforcer-pathology model proposed in this article. Based on the theoretical analyses and accumulated empirical evidence, theory-driven prevention and intervention strategies for problematic mobile phone use are proposed. Overall, the reinforcer-pathology model of problematic mobile phone use provides a comprehensive framework for understanding and addressing this growing issue.

Is it possible to identify physical-motor profiles of preschool children on their association with selected biosocial factors?

Biosocial factors play a crucial role in the physical-motor development (PMD) of children during the preschool age. The present study aims to identify physical-motor profiles throughout preschool age (3-6 years) and explore associations between profiles and selected biosocial factors such as age, sex, prematurity, weight, height, BMI, and participation in extracurricular physical activities. Data from 412 typically developing children (46.6% girls and 53.4% boys), aged 35-71 months (M = 51.21, SD = 10.47) was collected using the Psychomotor Activities Checklist and specifically the scale of Psycho-Motor Aspects. Cluster analysis made it possible to define four different childhood PMD profiles. High PMD; High PMD except left laterality; medium-low PMD; and low PMD. High PMD profile includes older children, with anthropometric measurements closer to the WHO recommendations, fewer preterm children, and greater participation in extracurricular physical activities. Low PMD profile includes younger children, with weight slightly above and height slightly below the WHO recommendations and low participation in extracurricular physical activities. This study allows us to identify specific trends that may be decisive for the motor development of children throughout preschool age, highlighting selected biological variables and participation in extracurricular physical activities.

The role of self-compassion and compassion toward others in burnout syndrome in a sample of medical students

Burnout produces negative effects on academic performance, and, in turn, feelings of inefficiency that are detrimental to students' psychosocial well-being. The aim of this research is to determine the effects that self-compassion and compassion toward others have on various burnout dimensions in a sample of medical students. A total of 235 medical students (61.7% women) aged between 16 and 32 years old (M = 19.82; SD = 2.37) belonging to a Colombian university participated. A cluster analysis to segment the population according to burnout was carried out along with nonparametric contrasts to identify differences in the levels of self-compassion and compassion toward others between each profile. A series of regression analyses was designed to find out how each type of compassion was associated with burnout on each profile. The cluster analysis allowed us to identify three profiles. The low-involvement profile (n = 51) is characterized by low depersonalization, intermediate levels of emotional exhaustion and personal accomplishment and exhibits low levels of self-compassion and compassion fatigue compared with the other profiles. The positive-adaptation profile (n = 104) is characterized by low depersonalization levels, intermediate degrees of emotional exhaustion and high levels of personal accomplishment and exhibits the highest levels of self-compassion and compassion fatigue compared with the other profiles. The high-demand profile (n = 104) is characterized by intermediate depersonalization levels, medium-high levels of emotional exhaustion and high levels of personal accomplishment and exhibits intermediate levels of self-compassion and low levels of compassion fatigue. Establishing profiles based on burnout allows students to be segmented and for precise knowledge to be acquired about the effects that both types of compassion have on the dimensions of burnout.

Disentangling the nuances of diversity ideologies

Objectives

Minoritized racial groups typically report greater psychological engagement and safety in contexts that endorse multiculturalism rather than colorblindness. However, organizational statements often contain multiple (sub)components of these ideologies. This research broadens our understanding of diversity ideologies in the real-world by: (1) mapping out the content of real-world organizational diversity ideologies, (2) identifying how different components tend to cluster in real-world statements, and (3) presenting these statements to minoritized group members (Study 2) to test how these individual components and clusters are perceived (e.g., company interest, value fit).

Methods

100 US university statements and 248 Fortune 500 company statements were content coded, and 237 racially minoritized participants (Mage = 28.1; 51.5% female; 48.5% male) rated their psychological perceptions of the Fortune 500 statements.

Results

While universities most commonly frame diversity ideologies in terms of value-in-equality, companies focus more on value-in-individual differences. Diversity rationales also differ between organizations, with universities focusing on the moral and business cases almost equally, but companies focusing on the business case substantially more. Results also offered preliminary evidence that minoritized racial group members reported a greater sense of their values fitting those of the organization when considering organizations that valued individual and group differences.

Conclusion

These are some of the first studies to provide a nuanced examination of the components and clusters of diversity ideologies that real-world organizations are using, ultimately with implications for how we move forward in studying diversity ideologies (to better reflect reality) and redesigning them to encourage more diverse and inclusive organizations.

Endorsing a Biopsychosocial Perspective of Pain in Individuals With Chronic Pain: Development and Validation of a Scale

OBJECTIVES

Patients' beliefs about pain play an important role in their readiness to engage with chronic pain self-management. The central aim of this study was to validate a self-report instrument to assess a specific set of pain beliefs, patients' endorsement of a biopsychosocial model of chronic pain Patients' Endorsement of a Biopsychosocial Model of Chronic Pain Scale (PEB).

METHODS

Interdisciplinary experts in the field of pain were involved in creating an instrument, the PEB Scale, to operationalize patients' endorsement of a biopsychosocial pain model. A sample of 199 patients with chronic pain was recruited to evaluate the factorial structure (principal axis factoring), the internal consistency (Cronbach alpha), the convergent and discriminant validity (correlational analyses), incremental validity (multiple, hierarchical regression analyses), and construct validity (differential population analysis) of the instrument.

RESULTS

The factor analysis resulted in a unidimensional, 11-item instrument that explained 51.2% of the total variance. Cronbach alpha (=0.92) indicated high internal consistency of the created set of pain-related beliefs. Regression analyses demonstrated that PEB is a strong predictor of patients' engagement with pain self-management ( P < 0.001) after controlling for demographic variables, anxiety, depression, and other pain-related beliefs.

DISCUSSION

Our results show that the PEB Scale is a highly reliable self-report instrument that has the potential to predict patients' readiness to adopt pain self-management. Future research should focus on revalidating the scale to operationalize PEB. Moreover, the PEB Scale should be implemented in longitudinal study designs to investigate its ability to predict the transition from acute to chronic pain and patients' long-term pain management.

A multi-year quantitative study of the experienced age-friendliness in The Hague: A tale of four personas

As an active member of the Global Network for Age-Friendly Cities and Communities, The Hague has been monitoring the progress over the years. In 2022, a second cross-sectional survey based on the Age Friendly Cities and Communities Questionnaire (AFCCQ) was conducted among 396 community-dwelling older citizens in the municipality. During times of the pandemic, scores for Social Participation went notably down, and scores for Respect and Social Inclusion increased. For the first time, based on survey data, four personas were found through cluster analysis. These personas ranged from the precariat and people with personal health issues with lower scores, to the silent majority without the limitations of health problems, and the upper echelon who score positively in all domains. Age-friendly policies in The Hague should focus particularly on the first two clusters through dedicated action plans, which would help steer efforts towards those most in need for support. This would help The Hague to become an age-friendly city for all, and not only for those living in good health and with sufficient financial means.

Profiles of historical loss and childhood trauma as predictors of mental and cardiometabolic health in American Indian adults

Cardiometabolic disease and mental health conditions are two major contributors to persistent inequities in health and life expectancy for American Indian adults. The atrocities associated with European colonization are linked to intergenerational psychological and emotional wounding (i.e., historical trauma) and high incidence of childhood trauma. Prior work has examined the independent relationships of childhood trauma and thoughts about historical loss with cardiometabolic and mental health in American Indians. In the current work, we used a data-driven approach to identify profiles of childhood trauma and frequency of thoughts about historical loss, and then examined how these profiles related to cardiometabolic and mental health in a sample of American Indian adults from across the United States (N = 727). We found that a profile characterized by high levels of childhood trauma and high frequency of thoughts about historical losses was associated with the greatest risk for mental health conditions. The profile characterized by the highest levels of childhood trauma and by moderate frequency of thoughts about historical losses was associated with the largest risk of cardiometabolic conditions. The findings represent an important first step towards understanding how childhood trauma and thoughts about historical loss may simultaneously inform enduring inequities in American Indian health.

Subtyping irritable bowel syndrome using cluster analysis: a systematic review

BACKGROUND

Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder associated with a wide range of clinical symptoms. Some researchers have used cluster analysis (CA), a group of non-supervised learning methods that identifies homogenous clusters within different entities based on their similarity.

OBJECTIVE AND METHODS

This literature review aims to identify published articles that apply CA to IBS patients. We searched relevant keywords in PubMed, Embase, Web of Science, and Scopus. We reviewed studies in terms of the selected variables, participants' characteristics, data collection, methodology, number of clusters, clusters' profiles, and results.

RESULTS

Among the 14 articles focused on the heterogeneity of IBS, eight of them utilized K-means Cluster Analysis (K-means CA), four employed Hierarchical Cluster Analysis, and only two studies utilized Latent Class Analysis. Seven studies focused on clinical symptoms, while four articles examined anocolorectal functions. Two studies were centered around immunological findings, and only one study explored microbial composition. The number of clusters obtained ranged from two to seven, showing variation across the studies. Males exhibited lower symptom severity and fewer psychological findings. The association between symptom severity and rectal perception suggests that altered rectal perception serves as a biological indicator of IBS. Ultra-slow waves observed in IBS patients are linked to increased activity of the anal sphincter, higher anal pressure, dystonia, and dyschezia.

CONCLUSION

IBS has different subgroups based on different factors. Most IBS patients have low clinical severity, good QoL, high rectal sensitivity, delayed left colon transit time, increased systemic cytokines, and changes in microbial composition, including increased Firmicutes-associated taxa and depleted Bacteroidetes-related taxa. However, the number of clusters is inconsistent across studies due to the methodological heterogeneity. CA, a valuable non-supervised learning method, is sensitive to hyperparameters like the number of clusters and random initialization of cluster centers. The random nature of these parameters leads to diverse outcomes even with the same algorithm. This has implications for future research and practical applications, necessitating further studies to improve our understanding of IBS and develop personalized treatments.

Differential impact on motor unit characteristics across severities of adult spinal muscular atrophy

OBJECTIVE

To test the hypotheses that decomposition electromyography (dEMG) motor unit action potential (MUAP) amplitude and firing rate are altered in SMA; dEMG parameters are associated with strength and function; dEMG parameters are correlated with traditional electrophysiological assessments.

METHODS

Ambulatory and non-ambulatory adults with SMA on nusinersen and healthy controls were enrolled. MUAPs were decomposed from multielectrode surface recordings during 30-s maximum contraction of the abductor digiti minimi (ADM). Isometric strength, upper limb function, patient-reported function, and standard electrophysiologic measures of the ADM (compound muscle action potential [CMAP], single motor unit potential [SMUP], motor unit number estimation [MUNE]) were collected.

RESULTS

dEMG MUAP amplitudes were higher in ambulatory versus control and non-ambulatory groups and were higher in controls versus non-ambulatory SMA. In contrast, dEMG firing rates were higher in ambulatory versus non-ambulatory and control groups but similar between non-ambulatory and control. dEMG parameters showed moderate to strong positive correlation with strength and function whereas CMAP and MUNE better correlated with function than strength. SMUP did not correlate with strength, function, or dEMG MUAP amplitude. dEMG parameters show overall good test-retest reliability.

INTERPRETATION

dEMG provided reliable, noninvasive measure of MUAP amplitude size and firing rate and revealed divergent patterns across disease severity in adults with SMA. Firing rate enhancement, as seen in milder SMA, may provide a therapeutic avenue for improving function in more severe SMA, where firing rates appear preserved. MUAP amplitude size and firing rate, quantified with dEMG, may be promising monitoring biomarker candidates for noninvasive assessment of SMA.

Self-focused autonomy, other-focused pro-sociality, and well-being: a cross-national cluster analysis

Through cluster analysis, this study seeks to identify various clusters that differ in the level of self-focused and other-focused caring (e.g., autonomy and pro-sociality) and to contrast the happiness and life satisfaction among them. This approach is based on the notion that unifying autonomy and pro-sociality is more advantageous than separating them for well-being, which follows the theories and empirical studies. The World Value Survey dataset (N = 76897; Mage = 43.02, SD = 16.37) is used, which uses random probability representative adult samples from 51 countries or territories. Results suggest that autonomy and pro-sociality both have distinct implications for happiness and life satisfaction. Four distinct clusters are identified: autonomous (high self-focused and low other-focused), prosocial (low self-focused and high other-focused), flourished (high self-focused and high other-focused), and indifferent (low self-focused and low other-focused). In terms of indicators of well-being, the flourished group has the highest levels of happiness and life satisfaction, followed by the autonomous group, the prosocial group, and the indifferent group. It appears that individuals who exhibit both high self-focused and high other-focused caring attain the greatest well-being. The implications, limitations, and potential directions for future research are discussed.

Association Between Insomnia, Stress Events, and Other Psychosocial Factors and Incident Atrial Fibrillation in Postmenopausal Women: Insights From the Women's Health Initiative

Background The association between psychosocial factors and atrial fibrillation (AF) is poorly understood. Methods and Results Postmenopausal women from the Women's Health Initiative were retrospectively analyzed to identify incident AF in relation to a panel of validated psychosocial exposure variables, as assessed by multivariable Cox proportional hazard regression and hierarchical cluster analysis. Among the 83 736 women included, the average age was 63.9±7.0 years. Over an average of 10.5±6.2 years follow-up, there were 23 954 cases of incident AF. Hierarchical cluster analysis generated 2 clusters of highly correlated psychosocial variables: the Stress Cluster included stressful life events, depressive symptoms, and insomnia, and the Strain Cluster included optimism, social support, social strain, cynical hostility, and emotional expressiveness. Incident AF was associated with higher values in the Stress Cluster (hazard ratio [HR], 1.07 per unit cluster score [95% CI, 1.05-1.09]) and the Strain Cluster (HR, 1.03 per unit cluster score [95% CI, 1.00-1.05]). Of the 8 individual psychosocial predictors that were tested, insomnia (HR, 1.04 [95% CI, 1.03-1.06]) and stressful life events (HR, 1.02 [95% CI, 1.01-1.04]) were most strongly associated with increased incidence of AF in Cox regression analysis after multivariate adjustment. Subgroup analyses showed that the Strain Cluster was more strongly associated with incident AF in those with lower traditional AF risks (P for interaction=0.02) as determined by the cohorts for heart and aging research in genomic epidemiology for atrial fibrillation score. Conclusions Among postmenopausal women, 2 clusters of psychosocial stressors were found to be significantly associated with incident AF. Further research is needed to validate these associations.

An overview of clustering methods with guidelines for application in mental health research

Cluster analyzes have been widely used in mental health research to decompose inter-individual heterogeneity by identifying more homogeneous subgroups of individuals. However, despite advances in new algorithms and increasing popularity, there is little guidance on model choice, analytical framework and reporting requirements. In this paper, we aimed to address this gap by introducing the philosophy, design, advantages/disadvantages and implementation of major algorithms that are particularly relevant in mental health research. Extensions of basic models, such as kernel methods, deep learning, semi-supervised clustering, and clustering ensembles are subsequently introduced. How to choose algorithms to address common issues as well as methods for pre-clustering data processing, clustering evaluation and validation are then discussed. Importantly, we also provide general guidance on clustering workflow and reporting requirements. To facilitate the implementation of different algorithms, we provide information on R functions and libraries.

Dispositional mindfulness and BIS/BAS up-close: can the self-regulation of people be seen in the eyes?

Introduction

Pigmentation in animal models is related to behavioral regulation and development, suggesting that both may belong to the same biological system. However, such models are poorly documented in humans. The current study explored personality and group differences in self-regulation among healthy subjects and their specific eye structures (contraction furrows and pigment spots). Three objectives were proposed: to analyze statistical differences in dispositional mindfulness (DM), behavioral inhibition system (BIS), and behavioral approach system (BAS) among subjects with a specific iris type of contraction furrows and pigment spots.

Methods

The study sample consisted of 194 university students. One month after taking photographs of their eyes, the students completed the online scales of DM, BIS, and BAS.

Results

DM was negatively related to pigment spots (rs = -0.193; p < 0.01). Cluster analysis of the iris structures converged at a four-cluster solution. The cluster types 2 (absence of pigment spots and contraction furrows extending 8/10 of iris circle or more) and 3 (one or more pigment spots and contraction furrows extending 8/10 of iris circle or more) significantly differed in DM with a small effect size (F = 3.37; p = 0.021; η2 = 0.051). Participants with contraction furrows (8/10 or more circle extent) and without pigment spots had a significantly higher DM than those with pigment spots. No significant differences existed among the iris types in BIS/BAS.

Discussion

Future research directions are suggested.

Relationships between the race implicit association test and other measures of implicit and explicit social cognition

Background

The race-based Implicit Association Test (IAT) was proposed to measure individual differences in implicit racial bias subsumed within social cognition. In recent years, researchers have debated the theoretical tenets underpinning the IAT, questioning whether performance on this task: (1) measures implicit attitudes that operate automatically outside of conscious awareness; (2) reflects individual differences in social cognition; and (3) can predict social behavior. One way to better address these research questions is to assess whether the race-IAT correlates with other implicit processes that are subsumed within social cognition.

Aims

The current study assessed whether the race-IAT was related to other commonly used individual difference measures of implicit (and explicit) social cognition. Experiment 1 assessed whether dissociable patterns of performance on the race-IAT were related to measures of implicit imitative tendencies, emotion recognition and perspective taking toward White task actors, as well as explicit measures of trait and state affective empathy and racial bias. Overcoming limitations of task conceptual correspondence, Experiment 2 assessed whether these latter tasks were sensitive in detecting racial biases by using both White and Black task actors and again examined their relationships with the race-IAT.

Method

In two lab-based experiments, 226 and 237 participants completed the race-IAT followed by an extensive battery of social cognition measures.

Results

Across both experiments, pro-White/anti-Black bias on the race-IAT was positively related to a pro-White bias on explicit measures of positive affective empathy. However, relationships between the race-IAT and implicit imitative tendencies, perspective taking, emotion recognition, and explicit trait and negative state affective empathy were statistically equivalent.

Conclusion

The race-IAT was consistently related to explicit measures of positive state affective empathy but not to other individual difference measures of implicit social cognition. These findings are discussed with regards to the theoretical underpinnings of the race-IAT as an individual difference measure of implicit social cognition, as well as alternative explanations relating to the reliability of social cognition measures and the various combinations of general-purpose (social and non-social) executive processes that underpin performance on these tasks.

"Classifying D/s Profiles Without Prior Assumptions: An Application of Cluster Analysis to Social Data"

Dominant/submissive role-play (D/s) is associated with specialized roles including Mistress, Master, Slave, Switch, Sadist, and Masochist. The current study uses cluster analysis to provide empirical evidence that no binary opposition or single spectrum constitutes a workable typology of individuals based on their affinities for these roles. The optimality of a particular choice of clustering scheme, including the number of clusters, is established using a replication technique which is presented in detail. A large number (n = 236,353) of individualized results (profiles) generated by the BDSM Test, a popular anonymous web survey, were analyzed. We hypothesize a two-dimensional typology of D/s profiles as the inferential result of our cluster analyses.

The Effects of the COVID-19-induced Lockdown on the Social Capital and Cultural Capital in Italy

The present study investigated the effects of the first COVID-19 lockdown on the Cultural and Social Capitals in Italy in a large group of adults (n = 1125). The relationships between the COVID-19 spread and participants' Cultural Capital, Social Capital, educational level, occupational prestige, and age were studied using structural equation models. For women but not for men, pandemic spread was positively affected by occupational prestige and it had a positive relationship with their Social Capital (women: CFI = 0.949; RMSEA = 0.059 [CI = 0.045-0.075]; men: CFI = 0.959; RMSEA = 0.064 [CI = 0.039-0.087]). Moreover, the participants were divided into three validated clusters based on their Cultural and Social Capitals levels to investigate changes in the Capitals compared with the pre-lockdown period. It was found that the lockdown contributed to improving the gap among individuals increasing high levels and decreasing low levels of both the Capitals. People with high Cultural and Social Capitals seemed to have seized the opportunity given by COVID-19 restrictions to cultivate their cultural interests and become more involved within their networks. In contrast, individuals with low Cultural and Social Capitals paid the highest price for the social isolation. Given that the Capitals encourage healthy behavior and influence well-being and mental health, institutions should develop or improve their policies and practices to foster individual resources, and make fairer opportunities available during the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11205-023-03140-7.

A hierarchical cluster analysis of young drivers based on their perceived risk and frequency of texting while driving

INTRODUCTION

The present study attempted to provide a proof-of-concept of usefulness of cluster analysis for identifying distinct and practically meaningful subgroups of drivers who differed in their perceived risk and frequency of texting while driving (TWD).

METHOD

Using a hierarchical cluster analysis, which involves sequential steps in which individual cases are merged together one at a time based on their similarities, the study first attempted to identify distinct subgroups of drivers who differed in their perceived risk and frequency of TWD. To further evaluate the meaningfulness of the subgroups identified, the subgroups were compared in terms of levels of trait impulsivity and impulsive decision making for each gender.

RESULTS

The study identified the following three distinct subgroups: (a) drivers who perceive TWD as risky but frequently engage in TWD; (b) drivers who perceive TWD as risky and infrequently engage in TWD; and (c) drivers who perceive TWD as not so risky and frequently engage in TWD. The subgroup of male, but not female, drivers who perceive TWD as risky but frequently engage in TWD showed significantly higher levels of trait impulsivity, but not impulsive decision making, than the other two subgroups.

DISCUSSION

This is the first demonstration that drivers who frequently engage in TWD can be categorized into two distinct subgroups that differ in terms of the perceived risk of TWD.

PRACTICAL APPLICATIONS

For drivers who perceived TWD as risky yet frequently engage in TWD, the present study suggests that different intervention strategies may be needed for each gender.

Preliminary evidence on machine learning approaches for clusterizing students’ cognitive profile

Assessing the cognitive abilities of students in academic contexts can provide valuable insights for teachers to identify their cognitive profile and create personalized teaching strategies. While numerous studies have demonstrated promising outcomes in clustering students based on their cognitive profiles, effective comparisons between various clustering methods are lacking in the current literature. In this study, we aim to compare the effectiveness of two clustering techniques to group students based on their cognitive abilities including general intelligence, attention, visual perception, working memory, and phonological awareness. 292 students, aged 11-15 years, participated in the study. A two-level approach based on the joint use of Kohonen's Self-Organizing Map (SOMs) and k-means clustering algorithm was compared with an approach based on the k-means clustering algorithm only. The resulting profiles were then predicted via AdaBoost and ANN supervised algorithms. The results showed that the two-level approach provides the best solution for this problem while the ANN algorithm was the winner in the classification problem. These results laying the foundations for developing a useful instrument for predicting the students' cognitive profile.

A machine learning approach on whole blood immunomarkers to identify an inflammation-associated psychosis onset subgroup

Psychosis onset is a transdiagnostic event that leads to a range of psychiatric disorders, which are currently diagnosed through clinical observation. The integration of multimodal biological data could reveal different subtypes of psychosis onset to target for the personalization of care. In this study, we tested the existence of subgroups of patients affected by first-episode psychosis (FEP) with a possible immunopathogenic basis. To do this, we designed a data-driven unsupervised machine learning model to cluster a sample of 127 FEP patients and 117 healthy controls (HC), based on the peripheral blood expression levels of 12 psychosis-related immune gene transcripts. To validate the model, we applied a resampling strategy based on the half-splitting of the total sample with random allocation of the cases. Further, we performed a post-hoc univariate analysis to verify the clinical, cognitive, and structural brain correlates of the subgroups identified. The model identified and validated two distinct clusters: 1) a FEP cluster characterized by the high expression of inflammatory and immune-activating genes (IL1B, CCR7, IL12A and CXCR3); 2) a cluster consisting of an equal number of FEP and HC subjects, which did not show a relative over or under expression of any immune marker (balanced subgroup). None of the subgroups was related to specific symptoms dimensions or longitudinal diagnosis of affective vs non-affective psychosis. FEP patients included in the balanced immune subgroup showed a thinning of the left supramarginal and superiorfrontal cortex (FDR-adjusted p-values < 0.05). Our results demonstrated the existence of a FEP patients' subgroup identified by a multivariate pattern of immunomarkers involved in inflammatory activation. This evidence may pave the way to sample stratification in clinical studies aiming to develop diagnostic tools and therapies targeting specific immunopathogenic pathways of psychosis.

Burnout in Italian anesthesiologists and intensivists during the COVID-19 pandemic: a national survey

BACKGROUND

COVID-19 pandemic added additional burden upon healthcare systems and anesthesiology and intensive care physicians (AI) who possessed crucial expertise for dealing with the pandemic. Aim of the study was to uncover specific burnout patterns among Italian AI, exploring the hypothesis that burnout has a multicluster structure. Differences in social and professional characteristics between burnout patterns were explored.

METHODS

One thousand and nine AI (658 women) members of the Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) working during COVID-19 pandemic participated. Sociodemographic, working information and burnout levels evaluated through Maslach Burnout Inventory (MBI) were collected.

RESULTS

According to the MBI cutoff, 39.7% and 25.8% of participants scored high in emotional exhaustion and depersonalization respectively, and 44.2% scored low in personal accomplishment. Cluster analysis highlighted four burnout profiles: resilience, detachment, burnout, and emotional reserve. The results showed that AI in the Resilience and Emotional Reserve groups were significantly older and more experienced than those in the Detachment and Burnout groups. Additionally, more of the individuals in the Resilience group were working in intensive care units and departments dedicated to COVID-19 patients. The Detachment group was comprised of more AI working in operating units, while the Burnout group contained a higher number of AI working in COVID-19 departments.

CONCLUSIONS

These findings highlight different burnout patterns in Italian AI: older age, more professional experience, and work in intensive care units and departments dedicated to COVID-19 seemed to be protective factors during the pandemic. This appears a first step to promote focused interventions.

Cluster-based psychological phenotyping and differences in anxiety treatment outcomes

The identification of markers of mental health illness treatment response and susceptibility using personalized medicine has been elusive. In the context of psychological treatment for anxiety, we conducted two studies to identify psychological phenotypes with distinct characteristics related to: psychological intervention modalities (mindfulness training/awareness), mechanism of action (worry), and clinical outcome (generalized anxiety disorder scale scores). We also examined whether phenotype membership interacted with treatment response (Study 1) and mental health illness diagnosis (Studies 1-2). Interoceptive awareness, emotional reactivity, worry, and anxiety were assessed at baseline in treatment-seeking individuals (Study 1, n = 63) and from the general population (Study 2, n = 14,010). In Study 1, participants were randomly assigned to an app-delivered mindfulness program for anxiety for two months or treatment as usual. Changes in anxiety were assessed 1 and 2 months post-treatment initiation. In studies 1-2, three phenotypes were identified: 'severely anxious with body/emotional awareness' (cluster 1), 'body/emotionally unaware' (cluster 2), and 'non-reactive and aware' (cluster 3). Study 1's results revealed a significant treatment response relative to controls (ps < 0.001) for clusters 1 and 3, but not for cluster 2. Chi-square analyses revealed that phenotypes exhibited significantly different proportions of participants with mental health diagnoses (studies 1-2). These results suggest that psychological phenotyping can bring the application of personalized medicine into clinical settings.Registry name and URL: Developing a novel digital therapeutic for the treatment of generalized anxiety disorder https://clinicaltrials.gov/ct2/show/NCT03683472?term=judson+brewer&draw=1&rank=1 .Trial registration: Registered at clinicaltrials.gov (NCT03683472) on 25/09/2018.

Outcomes of Acceptance and Commitment Therapy for depression and predictors of treatment response in Veterans Health Administration patients

BACKGROUND

Acceptance and Commitment Therapy for depression (ACT-D) is a promising depression treatment which has not been evaluated on a large scale within VA. This study aimed to evaluate ACT-D's effectiveness in a national, treatment-seeking sample of Veterans.

METHODS

The sample comprised 831 Veterans who received a primary depression diagnosis and received at least two sessions of ACT-D during fiscal years 2015-2020. We used GLM to measure predictors of symptom change, treatment response (50 % reduction in PHQ-9 and AAQ-II scores), subthreshold depression symptoms (PHQ-9 < 10; AAQ-II < 27), and treatment completion.

RESULTS

Veterans experienced an average reduction of 3.39 points on the PHQ-9 (Cohen's d = 0.56) and 3.76 points on the AAQ-II (Cohen's d = 0.43). On the PHQ-9, 40 % achieved subthreshold depression symptoms. On the AAQ-II, 36 % of Veterans achieved subthreshold psychological inflexibility scores. Service-connected disability rating for depression and higher levels of medical comorbidity were both related to lower levels of overall depression symptom change and treatment response. Substance use disorder and bipolar/psychosis diagnoses were associated with greater reductions in psychological inflexibility.

LIMITATIONS

This is an observational study without a control group, so we were unable to compare the effectiveness of ACT-D to other usual care for depression. We were also unable to assess variables that can influence treatment success, such as therapist fidelity and patient engagement.

CONCLUSIONS

ACT-D achieved similar improvements in depression as reported in controlled trials. Adaptations to ACT-D may be needed to improve outcomes for Veterans with depression and comorbid PTSD.

The sound of stress recovery: an exploratory study of self-selected music listening after stress

BACKGROUND

Empirical support for the notion that music listening is beneficial for stress recovery is inconclusive, potentially due to the methodological diversity with which the effects of music on stress recovery have been investigated. Little is presently known about which recovery activities are chosen by individuals for the purpose of stress recovery, and whether audio feature commonalities exist between different songs that are selected by individuals for the purpose of stress recovery. The current pre-registered study investigated whether audio feature commonalities can be extracted from self-selected songs for the purpose of stress recovery. Furthermore, the present study exploratorily examined the relationship between audio features and participants' desired recovery-related emotions while listening and after listening to self-selected music.

METHODS

Participants (N = 470) completed an online survey in which they described what music they would listen to unwind from a hypothetical stressful event. Data analysis was conducted using a split-sample procedure. A k-medoid cluster analysis was conducted to identify audio feature commonalities between self-selected songs. Multiple regression analyses were conducted to examine the relationship between audio features and desired recovery emotions.

RESULTS

Participants valued music listening as a recovery activity to a similar extent as watching TV, sleeping, or talking to a significant other. Cluster analyses revealed that self-selected songs for the purpose of stress recovery can be grouped into two distinct categories. The two categories of songs shared similarities in key, loudness, speechiness, acousticness, instrumentalness, liveness, musical valence, tempo, duration, and time signature, and were distinguished by danceability, energy, and mode. No audio features were significantly associated with participants' desired recovery emotions.

CONCLUSIONS

Although a comprehensive portrait of the relationship between audio features and stress recovery still warrants further research, the present study provides a starting point for future enquiries into the nuanced effects of musical audio features on stress recovery.

Gait biomechanics phenotypes among total knee arthroplasty candidates by machine learning cluster analysis

Knee osteoarthritis patient phenotyping is relevant to developing targeted treatments and assessing the treatment efficacy of total knee arthroplasty (TKA). This study aimed to identify clusters among TKA candidates based on demographic and knee mechanic features during gait, and compare gait changes between clusters postoperatively. TKA patients underwent 3D gait analysis 1-week pre (n = 134) and 1-year post-TKA (n = 105). Principal component analysis was applied to frontal and sagittal knee angle and moment waveforms, extracting major patterns of variability. Age, sex, body mass index, gait speed, and frontal and sagittal pre-TKA angle and moment PC scores previously identified as relevant to TKA outcomes were standardized (mean = 0, SD = 1, [134 × 15]). Multidimensional scaling and machine learning-based hierarchical clustering were applied. Final clusters were validated by examining intercluster differences pre-TKA and gait feature changes (Post_PCscore  - Pre_PCscore ) by k-way Χ² and ANOVA tests. Four TKA candidate phenotypes yielded optimum clustering metrics, interpreted as higher and lower functioning clusters that were predominantly male and female. Higher functioning clusters pre-TKA (clusters 1 and 4) had more dynamic sagittal flexion moment (p < 0.001) and frontal plane adduction moment (p < 0.001) loading/un-loading patterns during stance. Post-TKA, higher functioning clusters demonstrated less knee mechanic improvements during gait (flexion angle p < 0.001; flexion moment p < 0.001). TKA candidates can be characterized by four clusters, predominately separated by sex and knee joint biomechanics. Post-TKA knee kinematics and kinetics improvements were cluster-specific; lower functioning clusters experienced more improvement. Cluster-based patient profiling may aid in triaging and developing OA management and surgical strategies meeting group-level function needs.

A mixed-method study on adolescents' well-being during the COVID-19 syndemic emergency

In this study, we set out to investigate adolescents' levels of perceived well-being and to map how they went about caring for their well-being during the COVID-19 syndemic. Participants were 229 Italian adolescent high school students (48.9% males, mean age = 16.64). The research design was based on an exploratory, parallel, mixed-method approach. A multi-method, student-centered, computer-assisted, semi-structured online interview was used as the data gathering tool, including both a standardized quantitative questionnaire on perceived well-being and an open-ended question about how adolescents were taking charge of their well-being during the COVID-19 health emergency. Main findings reveal general low levels of perceived well-being during the syndemic, especially in girls and in older adolescents. Higher levels of well-being are associated with more affiliative strategies (we-ness/togetherness) whereas low levels of well-being are linked with more individualistic strategies (I-ness/separatedness) in facing the health emergency. These findings identify access to social support as a strategy for coping with situational stress and raise reflection on the importance of balancing the need for physical distancing to protect from infection, and the need for social closeness to maintain good mental health.

The "affected" pharmacist and the "business as usual" pharmacist: Exploring the experiences of pharmacists during COVID-19 through cluster analysis

BACKGROUND

The global coronavirus disease 2019 (COVID-19) pandemic has necessitated considerable changes in the delivery of pharmacy services, with pharmacists experiencing increasing demands and a high rate of burnout. The ability to categorize pharmacists based on their burnout risk and associated factors could be used to tailor burnout interventions.

OBJECTIVE

This study aimed to identify subgroups (profiles) of pharmacists and use these profiles to describe interventions tailored to improve pharmacist's well-being.

METHODS

A survey was disseminated to pharmacists working in Australia during April and June 2020. The survey measured demographics, burnout, and psychosocial factors associated with working during COVID-19. A two-step cluster analysis was used to categorize pharmacists based on burnout and other variables.

RESULTS

A total of 647 survey responses contained data that were used for analysis. Participants were mostly female (75.7%) and working full time (65.2%). The final cluster analysis yielded an acceptable two-cluster model describing 2 very different pharmacist experiences, using 10 variables. Cluster 2 (representing 53.1% of participants) describes the "affected" pharmacist, who has a high degree of burnout, works in community pharmacy, experiences incivility, is less likely to report sufficient precautionary measures in their workplace, and has had an increase in workload and overtime. In contrast, cluster 1 (representing 46.9% of participants) describes the profile of a "business as usual" hospital pharmacist with the opposite experiences. Interventions focused on the "affected" pharmacist such as financial support to employ specialized staff and equitable access to personal protective equipment should be available to community pharmacists, to reduce the risk to these frontline workers.

CONCLUSION

The use of cluster analysis has identified 2 distinct profiles of pharmacists working during COVID-19. The "affected" pharmacist warrants targeted interventions to address the high burnout experienced in this group.

It's not what you do, it's the way that you do it: An experimental task delineates among passive, reactive and interactive styles of behaviour on social networking sites

Studies have produced vastly disparate findings when exploring relationships between social networking site (SNS) usage and psychosocial well-being. These inconsistencies might reflect a lack of consideration for how people use SNS; specifically, while meaningful interactions are suggested to foster positive feelings, the passive consumption of others' feeds is proposed to have negative effects on users' well-being. To facilitate the empirical evaluation of these claims, the present study developed a computerised task to measure styles of usage on a mock SNS platform. Administering this Social Network Site Behaviour Task (SNSBT) online to 526 individuals, we identified three dissociable usage styles that extend the active-passive dichotomy employed frequently in the literature: passive use (consuming content posted by others), reactive use (reacting to others' content), and interactive use (interacting with others through content sharing). Furthermore, our data reveal that these usage styles differ on several measures of psychosocial variables employed frequently in the disparate literature: more interactive users reported greater feelings of social connectedness and social capital than passive or reactive users. Importantly, however, our results also reveal the multi-dimensional nature of usage styles, with online network size and time spent on SNS platforms serving as potentially confounding influences on some psychosocial measures. These findings not only advance our understanding of SNS behaviour by providing empirical support for theoretic propositions, but also demonstrate the utility of the SNSBT for experimental investigations into the psychosocial outcomes of different SNS usage styles.

A cluster analysis of high-performance female team players' perceived motivational climate: Implications on perceived motor competence and autonomous behaviour

High performance sport for females is an area which is gaining more and more relevance today, but which hasn't received the same research interest as sport for males. The aim of the present study was to analyse the motivational climate perceived by high performance female athletes and the implications on perceived motor competence and autonomous behaviour and check the differences according category, sport experience and training hours in performance and master climate. The participants were 615 female athletes who practice top level team sports, with ages comprised of 16 to 38 (M = 22,10; SD = 4,91). The sample consisted of two different categories: junior (n = 242) and senior (n = 373). These players participated in different team sports, specifically football, handball, basketball and volleyball, training between 6 and 24 hours a week (M = 8,34; DT = 4,33). The variables measured were: perceived motivational climate in sport, autonomous behaviour and perceived motor competence. A cluster analysis was carried out using, as a variable, the perceived motivational climate, and showing the existence of two profiles, one related to ego and the other to task. The multivariate analysis showed that the profile orientated towards the task had significant differences compared to the autonomous behaviour (M = 4.66 vs M = 3.41). At the same time an analysis was carried out looking at different social demographic variables, revealing how there were differences in the sports experience (those participants with more than ten years' experience were more orientated towards ego, compared to those with less than ten years' experience) and the category (junior athletes were more orientated towards the task, compared to senior athletes). It was concluded that a greater orientation towards the task can lead to an improvement in the perception of motor competence, with the youngest and least experienced athletes being the most prominent in this category.

Who improves in trauma-focused treatment: A cluster analysis of treatment response in VA patients undergoing PE and CPT

BACKGROUND

Although most veterans with posttraumatic stress disorder (PTSD) benefit from evidence-based treatments, questions persist concerning the profiles of those at risk for poor outcomes. To help address these gaps, this study analyzed a large clinical cohort of veterans receiving prolonged exposure (PE) or cognitive processing therapy (CPT).

METHODS

Cluster analysis using Ward's method with Euclidian distances identified clinically meaningful subgroups of veterans in a national cohort (n = 20,848) using variables maintained in the electronic medical record. The clusters were then compared via one-way analysis of variance and Tukey's HSD on indicators of treatment progress including PTSD symptom change, clinical recovery, clinically significant change, remission, and treatment completion.

RESULTS

Effect size differences on clinical outcome measures for PE and CPT were negligible. Less than half of veterans achieved at least a 15-point reduction in PCL-5 score and half completed treatment. We identified 10 distinct clusters. Higher rates of PTSD service-connected disability were linked to poorer outcomes across multiple clusters, especially when combined with Post-Vietnam service era. Non-White race was also linked with poorer clinical outcomes. Factors associated with better outcomes included a greater proportion of female veterans, especially when combined with recent service era, and longer PTSD diagnosis duration.

CONCLUSIONS

This study suggests the need to improve PTSD treatment outcomes for non-White and male veterans, examine treatment response in Post-Vietnam era veterans, and consider ways in which the service connection process could hinder treatment response. The results from this study also indicate the benefits of integrating elements of clinical complexity into an analytic approach.

Statistical and clustering validation analysis of primary students' learning outcomes and self-awareness of information and technical online security problems at a post-pandemic time

The authors decided to investigate the impact of the pandemic period and the resulting limitations in Polish primary school online security education. The first part of the study investigates the impact of the COVID-19 pandemic on students' educational learning outcomes in information and Internet security. The study has been performed via a student-oriented survey of 20 questions. The statistical analysis confirms the significant difference before and after the pandemic in several questions at most. Nevertheless, this justifies the statement that pandemics had a positive impact on post-pandemic Internet-related security education. The second part of the study has been focused on students' perception and self-awareness of cyberspace problems. For this purpose, the authors used novel majority-based decision fusion clustering validation methods. The revealed results illustrate the positive tendency toward the students' self-awareness and self-confidence of online security problems and e-threats before, during and after the challenging pandemic period. Moreover, the presented validation methods show the appealing performance in educational data analysis, and therefore, the authors recommended these methods as a preprocessing step that helps to explore the intrinsic data structures or students' behaviors and as a postprocessing step to predict learning outcomes in different educational environments.

New Work Poses New Challenges-The Importance of Work Design Competencies Revealed in Cluster Analysis

The continuous transformation process in the world of work, intensified by the COVID-19 pandemic, is giving employees more scope to shape their own work. This scope can be experienced as a burden or as a resource for employees. Work design competencies (WDC) describe employees' experience of their scope for design. Our study draws on existing datasets based on two Germany-wide studies. We used hierarchical cluster analyses to examine patterns between WDC, the age of employees (range: 18-71 years), the amount of weekly work time working from home (WFH), and work ability. In total, the data of N = 1232 employees were analyzed, and 735 of them participated in Study 1. To test the validity of the clusters, we analyzed data from N = 497 employees in Study 2. In addition, a split-half validation was performed with the data from Study 1. In both studies, three clusters emerged that differed in age and work ability. The cluster with the highest mean of WDC comprised employees that were on average older and reported a higher mean of work ability. Regarding WFH, no clear patterns emerged. The results and further theoretical and practical implications are discussed. Overall, WDC appear to be relevant to work ability and, in a broader sense, to occupational health, and are related to sociodemographic factors such as age.

I'm fine with collecting data: Engagement profiles differ depending on scientific activities in an online community of a citizen science project

Digital technologies facilitate collaboration between citizens and scientists in citizen science (CS) projects. Besides the facilitation of data transmission and access, digital technologies promote novel formats for education in CS by including citizens in the process of collecting, analyzing, and discussing data. It is usually assumed that citizens profit more from CS the more they participate in the different steps of the scientific process. However, it has so far not been analyzed whether citizens actually engage in these steps. Therefore, we investigated citizens' actual engagement in different scientific steps online (i.e., data collection and data analysis) in two field studies of a CS project. We then compared them with other CS projects. We analyzed behavioral engagement patterns of N = 273 participants with activity logs and cluster analyses. Opportunities to engage in different steps of the scientific process increased participants' overall commitment compared to contributory CS projects. Yet, despite their increased commitment, participants' engagement was only more active for data collection but not for data analysis. We discuss how participants' perceived role as data collectors influenced their actual engagement in the scientific steps. To conclude, citizens may need support to change their role from data collectors to data inquirers.

Segmentation of intentions towards COVID-19 vaccine acceptance through political and health behaviour explanatory models

BACKGROUND

Management of the COVID-19 pandemic has been plagued by an online 'infodemic', not least on the topic of vaccine safety. Failure to vaccinate is often addressed with corrective, factually based information. However, this may be overly simplistic. European vaccine hesitancy levels correlate closely with popularity of populist parties while scientific populism refers specifically to populist distrust in scientific expertise.

AIMS AND METHOD

Combining an evaluation of risk through the health belief model and the cognitive constructs from the theory of planned behaviour, with the influence of populist statements, anticipated regret, trust, and past healthcare behaviour, an online survey explored the components of vaccine decisions amongst a demographically representative Irish adult sample (N = 1995).

RESULTS

The regression model accounted for a large proportion of variance amongst the total sample. A primary set of influences suggests a considered risk evaluative decision-making approach while a second tier of weaker influences incorporates a broader set of values beyond cost-benefit analysis. Six ideological subsets were identified through K-means analysis. Segments were differentiated by subjective norms attitudes (particularly around social media), populist political attitudes, self-efficacy, perceptions of COVID-19 severity, and susceptibility to the condition.

CONCLUSIONS

While the 'right thing to do' is clear when viewed through a lens of scientific expert advice, this is precisely the paradigm which populist movement rejects. Segmentations, such as the outputs from this study, validate the importance of proactively engaging with diverse communities both on and offline and afford a framework for developing and evaluating more refined, targeted, policies and interventions.

Computational Methods in Psychotherapy: A Scoping Review

BACKGROUND

The study of complex systems, such as the psychotherapeutic encounter, transcends the mechanistic and reductionist methods for describing linear processes and needs suitable approaches to describe probabilistic and scarcely predictable phenomena.

OBJECTIVE

The present study undertakes a scoping review of research on the computational methods in psychotherapy to gather new developments in this field and to better understand the phenomena occurring in psychotherapeutic interactions as well as in human interaction more generally.

DESIGN

Online databases were used to identify papers published 2011-2022, from which we selected 18 publications from different resources, selected according to criteria established in advance and described in the text. A flow chart and a summary table of the articles consulted have been created.

RESULTS

The majority of publications (44.4%) reported combined computational and experimental approaches, so we grouped the studies according to the types of computational methods used. All but one of the studies collected measured data. All the studies confirmed the usefulness of predictive and learning models in the study of complex variables such as those belonging to psychological, psychopathological and psychotherapeutic processes.

CONCLUSIONS

Research on computational methods will benefit from a careful selection of reference methods and standards. Therefore, this review represents an attempt to systematise the empirical literature on the applications of computational methods in psychotherapy research in order to offer clinicians an overview of the usefulness of these methods and the possibilities of their use in the various fields of application, highlighting their clinical implications, and ultimately attempting to identify potential opportunities for further research.

Different clusters of perfectionism in inpatients with anorexia nervosa and healthy controls

Perfectionism is a risk and maintaining factor for anorexia nervosa (AN) but studies on its classification are lacking. This study aimed to classify patients with AN and healthy controls (HCs) according to their perfectionism; to evaluate the association between perfectionism clusters and severity of general and eating psychopathology for both groups; to investigate the relationship between baseline perfectionism and hospitalization outcome for patients. A sample of 207 inpatients with AN and 292 HCs completed: Eating Disorders Inventory-2, Frost Multidimensional Perfectionism Scale, Beck Depression Inventory, and State- Trait Anxiety Inventory. Cluster analyses were run to classify participants according to their perfectionism scores. Three clusters (i.e., high, medium, low perfectionism) emerged for both patients with AN and HCs. The high perfectionism cluster was over-represented among patients. Both groups reported significant differences across clusters in eating-related difficulties. In AN, anxiety and depression severity varied across clusters according to perfectionism, but patients' baseline perfectionism was unrelated to hospitalization outcome. Inpatients with AN and HCs could be grouped in clusters of high, medium, and low perfectionism which also mirrored their eating psychopathology severity. Finally, hospitalization outcome was unrelated to inpatients' baseline perfectionism.

Chewing Revenge or Becoming Socially Desirable? Anger Rumination in Refugees and Immigrants Experiencing Racial Hostility: Latin-Americans in Spain

This paper explores how real scenarios of racial hostility and discrimination trigger anger rumination tendencies in refugees, asylum seekers and immigrants (hereafter RASI). Undergoing discrimination often leads to the development of negative thoughts and behaviors, and to a loss of meaning and self-worth. This could make young RASI particularly vulnerable to being recruited and exploited by extremist groups as they search for identity. We developed a picture-elicitation instrument (the PEI) to provide professionals with a tool that could identify groups of RASI according to their reactions to discrimination scenarios and explore how racial hostility might influence withdrawal levels. The tool was applied with the Anger Rumination Scale (ARS_19) to 509 RASI of Latin American origin living in Spain. Four categories were identified, according to how RASI processed anger when observing discrimination scenarios: “Social desirability”, “Chewing”, “Grudge”, and “Vengeful”. Further analyses showed that the youngest (18–29) fell under the “Grudge” and “Vengeful” categories and revealed more despair and social isolation. This study makes a positive contribution by being the first to investigate the problem of anger rumination in RASI undergoing racial hostility. Moreover, it equips professionals with two tools that, once validated, may help plan and implement strategies to reduce the impact of hostility on both RASI and their host societies.

Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year

Objective

Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later.

Methods

In this observational, longitudinal study, patients with chronic pain (n = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19–related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism.

Results

A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism.

Conclusions

An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future.

Differences in personality functioning impairment in mood, anxiety, and personality disorders: a cluster analysis

BACKGROUND

The Alternative DSM-5 Model for Personality Disorders and the latest eleventh version of the International Classification of Diseases implement the level of impairment in self and interpersonal personality functioning (Level of Personality Functioning Scale - LPFS) as a core feature of personality pathology. However, some studies have indicated that personality functioning is also impaired in other mental disorders, but a more thorough exploration is missing. Thus, this study aims to develop profiles of levels of personality functioning in people with personality disorders and some other psychiatric diagnoses as well as without diagnosis.

METHODS

One-hundred-forty-nine people participated in the study. They came from three groups - healthy controls (n = 53), people with personality disorders (n = 58), and people with mood and anxiety disorders (n = 38). The LPFS was assessed by the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1). An optimal clustering solution using agglomerative hierarchical cluster analysis was generated to represent profiles of personality functioning.

RESULTS

The two patient groups showed significantly higher levels of personality functioning impairment than healthy controls. People with personality disorders showed higher levels of impairment than the other groups. In addition, the clustering analysis revealed three distinct profiles of personality functioning.

CONCLUSIONS

The impairment of personality functioning seems to be useful in the clinical assessment of other than personality disorders as well. As the resulting clustering profiles suggest, LPFS can be seen as an overall indicator of the severity of mental health difficulties and the presence of mental disorders symptoms. The LPFS provides valuable and detailed information about the individual's mental health and can thus serve as a broad basis for case formulation, treatment and therapy planning, and prognosis.

Latent Tuberculosis Infection Diagnosis among Household Contacts in a High Tuberculosis-Burden Area: a Comparison between Transcript Signature and Interferon Gamma Release Assay

Diagnosis of latent tuberculosis infection (LTBI) using biomarkers in order to identify the risk of progressing to active TB and therefore predicting a preventive therapy has been the main bottleneck in eradication of tuberculosis. We compared two assays for the diagnosis of LTBI: transcript signatures and interferon gamma release assay (IGRA), among household contacts (HHCs) in a high tuberculosis-burden population. HHCs of active TB cases were recruited for our study; these were confirmed to be clinically negative for active TB disease. Eighty HHCs were screened by IGRA using QuantiFERON-TB Gold Plus (QFT-Plus) to identify LTBI and uninfected cohorts; further, quantitative levels of transcript for selected six genes (TNFRSF10C, ASUN, NEMF, FCGR1B, GBP1, and GBP5) were determined. Machine learning (ML) was used to construct models of different gene combinations, with a view to identify hidden but significant underlying patterns of their transcript levels. Forty-three HHCs were found to be IGRA positive (LTBI) and thirty-seven were IGRA negative (uninfected). FCGR1B, GBP1, and GBP5 transcripts differentiated LTBI from uninfected among HHCs using Livak method. ML and ROC (Receiver Operator Characteristic) analysis validated this transcript signature to have a specificity of 72.7%. In this study, we compared a quantitative transcript signature with IGRA to assess the diagnostic ability of the two, for detection of LTBI cases among HHCs of a high-TB burden population; we concluded that a three gene (FCGR1B, GBP1, and GBP5) transcript signature can be used as a biomarker for rapid screening.

IMPORTANCE The study compares potential of transcript signature and IGRA to diagnose LTBI. It is first of its kind study to screen household contacts (HHCs) in high TB burden area of India. A transcript signature (FCGR1B, GBP1, & GBP5) is identified as potential biomarker for LTBI. These results can lead to development of point-of-care (POC) like device for LTBI screening in a high TB burdened area.

Are You "Nudgeable"? Factors Affecting the Acceptance of Healthy Eating Nudges in a Cafeteria Setting

Research has identified nudging as a promising and effective tool to improve healthy eating behavior in a cafeteria setting. However, it remains unclear who is and who is not “nudgeable” (susceptible to nudges). An important influencing factor at the individual level is nudge acceptance. While some progress has been made in determining influences on the acceptance of healthy eating nudges, research on how personal characteristics (such as the perception of social norms) affect nudge acceptance remains scarce. We conducted a survey on 1032 university students to assess the acceptance of nine different types of healthy eating nudges in a cafeteria setting with four influential factors (social norms, health-promoting collaboration, responsibility to promote healthy eating, and procrastination). These factors are likely to play a role within a university and a cafeteria setting. The present study showed that key influential factors of nudge acceptance were the perceived responsibility to promote healthy eating and health-promoting collaboration. We also identified three different student clusters with respect to nudge acceptance, demonstrating that not all nudges were accepted equally. In particular, default, salience, and priming nudges were at least moderately accepted regardless of the degree of nudgeability. Our findings provide useful policy implications for nudge development by university, cafeteria, and public health officials. Recommendations are formulated for strengthening the theoretical background of nudge acceptance and the susceptibility to nudges.

Shame

Abstract. While shame is sometimes discussed as a key element at the core of personality pathologies, its relationship with pathological personality traits is still understudied. Previous research suggested that shame is a common subjective experience in patients with borderline and narcissistic personality traits. However, little is known about how borderline and narcissistic traits are associated with specific areas of shame in community samples. The present study aims to investigate these associations, using a dual strategy, that is, both at “variable-level” using correlational analyses and at “person-level” using a cluster-analytic strategy with borderline and narcissistic (grandiose and vulnerable) personality traits as clustering variables. A total of 254 French-Canadian adult participants were recruited to complete an online battery of self-report questionnaires. Correlational analyses revealed that borderline-related traits and narcissistic vulnerability showed some significant and meaningful differences pertaining to Behavioral shame while sharing a similar pattern of associations with Characterological and Bodily shame. Alternatively, shame does not appear to be a strong correlate of narcissistic grandiosity, although some significant – and somewhat unexpected – positive associations between the two were found. Cluster analysis yielded four groups based on their levels of pathological traits; the groups showed indiscriminate associations with different shame areas, suggesting that the association between shame and pathological traits is more global and less area specific.

Exploring the Heterogeneity and Trajectories of Positive Functioning Variables, Emotional Distress, and Post-traumatic Growth During Strict Confinement Due to COVID-19

COVID-19 pandemic-related confinement may be a fruitful opportunity to use individual resources to deal with it or experience psychological functioning changes. This study aimed to analyze the evolution of different psychological variables during the first coronavirus wave to identify the different psychological response clusters, as well as to keep a follow-up on the changes among these clusters. The sample included 459 Spanish residents (77.8% female, M_age = 35.21 years, SD_age = 13.00). Participants completed several online self-reported questionnaires to assess positive functioning variables (MLQ, Steger et al. in J Loss Trauma 13(6):511-527, 2006. 10.1080/15325020802173660; GQ-6, McCullough et al. in J Person Soc Psychol 82:112-127, 2002. 10.1037/0022-3514.82.1.112; CD-RISC, Campbell-Sills and Stein in J Traum Stress 20(6):1019-1028, 2007. 10.1002/jts.20271; CLS-H, Chiesi et al. in BMC Psychol 8(1):1-9, 2020. 10.1186/s40359-020-0386-9; SWLS; Diener et al. in J Person Assess, 49(1), 71-75, 1985), emotional distress (PHQ-2, Kroenke et al. in Med Care 41(11):1284-1292, 2003. 10.1097/01.MLR.0000093487.78664.3C; GAD-2, Kroenke et al. in Ann Internal Med 146(5):317-325, 2007. 10.7326/0003-4819-146-5-200703060-00004; PANAS, Watson et al. in J Person Soc Psychol 47:1063-1070, 1988; Perceived Stress, ad hoc), and post-traumatic growth (PTGI-SF; Cann et al. in Anxiety Stress Coping 23(2):127-137, 2010. 10.1080/10615800903094273), four times throughout the 3 months of the confinement. Linear mixed models showed that the scores on positive functioning variables worsened from the beginning of the confinement, while emotional distress and personal strength improved by the end of the state of alarm. Clustering analyses revealed four different patterns of psychological response: "Survival", "Resurgent", "Resilient", and "Thriving" individuals. Four different profiles were identified during mandatory confinement and most participants remained in the same cluster. The "Resilient" cluster gathered the largest number of individuals (30-37%). We conclude that both the heterogeneity of psychological profiles and analysis of positive functioning variables, emotional distress, and post-traumatic growth must be considered to better understand the response to prolonged adverse situations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-021-00469-z.