Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Repetition suppression between monetary loss and social pain

The relationship between monetary loss and pain has been a recent research focus. Prior studies found similarities in the network representation patterns of monetary loss and pain, particularly social pain. However, the neural level evidence was lacking. To address this, we conducted an ERP experiment to investigate whether there is a repetitive suppression effect of monetary loss on the neural activity of social pain, aiming to understand if they engage overlapping neuronal populations. The results revealed that FRN amplitudes showed repetitive suppression effects of monetary loss on the neural activity of social pain. Our study suggests that monetary loss and social pain share common neural bases, indicating that they might involve shared neural modules related to cognitive conflict and affective appraisal.

Psychometric properties and item response theory analysis of the Persian version of the social pain questionnaire

Introduction

Social pain is an emotional reaction which is triggered by social exclusion and has been extensively investigated in the literature. The Social Pain Questionnaire (SPQ) is a self-report instrument which is the only scale for measuring social pain as a dispositional factor. The current study aimed at examining the psychometric properties of the SPQ in an Iranian sample.

Materials and methods

A sample of participants (N = 400) was recruited in a cross-sectional validation study. Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were conducted. The Item Response Theory (IRT) model parameters were evaluated and item response category curves were presented. Convergent and divergent validities as well as the reliability (by using Cronbach's alpha coefficient) were also assessed.

Results

The SPQ's unidimensionality was affirmed (RMSEA = 0.078; CFI = 0.915; TLI = 0.99) and its internal consistency was robust (Cronbach's α = 0.94). The correlation between the SPQ and the following measures endorsed its divergent and convergent validity: Self-esteem (r = -0.424), Perceived Social Support (r = -0.161), and Interpersonal Sensitivity (r = 0.636). Finally, Item Response Theory Analysis emphasized the effectiveness of the SPQ items in discerning various levels of social pain. The theta level ranged between -1 and + 1.2 and the IRT-based marginal reliability was 0.92 for the total score.

Discussion

The Persian SPQ stands as a reliable and valid measure for evaluating social pain. This scale has the potential to stimulate further research in the field for both clinical and non-clinical settings.

Conclusion

By employing Item Response Theory (IRT) analysis, we have transcended the theoretical psychometric evaluation of the SPQ scale and demonstrated that SPQ is a unidimensional, valid and reliable measurement tool.

Impairment of Hypnosis by Nocebo Response and Related Neurovegetative Changes: A Case Report in Oral Surgery

This article presents the third molar removal in a highly hypnotizable patient, who had been successfully submitted to oral surgery with hypnosis as stand-alone anesthesia in previous sessions. Unexpectedly, hypnosis initially failed, as a result of a nocebo response due to a previous dentist's bad communication; two complaints made by the patient were associated with increased sympathetic activity (as defined by increased heart rate and electrodermal activity and decreased heart rate variability). After deepening of hypnosis, the patient achieved a full hypnotic analgesia allowing for a successful conclusion of the intervention, an event associated with decreased heart rate, electrodermal activity, and increased heart rate variability. Hence, the initial failure was paralleled by a decreased parasympathetic activity and increased sympathetic activity, while hypnotic analgesia was associated with the opposite pattern. The patient's postoperative report indicated that the initial failure of hypnosis depended on a strong nocebo effect because of a previous dentist distrusting hypnosis and persuading her that it was not enough to face a third molar removal.

The dual facilitatory and inhibitory effects of social pain on physical pain perception

Pain is a multi-dimensional phenomenon that encompasses both physical pain experienced physiologically and social pain experienced emotionally. The interactions between them are thought to lead to increased pain load. However, the effect of social pain on physical pain perception during interactions remains unclear. Four experiments were conducted merging physical and social pains to examine the behavioral pattern and neural mechanism of the effect of social pain on physical pain perception. Seemingly paradoxical effects of social pain were observed, which both facilitated and inhibited physical pain perception under different attention orientations. Brain imaging revealed that the posterior insula encoded the facilitatory effect, whereas the frontal pole engaged in the inhibitory effect. At a higher level, the thalamus further modulated both processes, playing a switch-like role under different concern statuses of social pain. These results provide direct evidence for the dual-pathway mechanism of the effect of social pain on physical pain.

Alcohol use and the pain system

The World Health Organization's epidemiological data from 2016 revealed that while 57% of the global population aged 15 years or older had abstained from drinking alcohol in the previous year, more than half of the population in the Americas, Europe, and Western Pacific consumed alcohol. The spectrum of alcohol use behavior is broad: low-risk use (sensible and in moderation), at-risk use (e.g., binge drinking), harmful use (misuse) and dependence (alcoholism; addiction; alcohol use disorder). The at-risk use and misuse of alcohol is associated with the transition to dependence, as well as many damaging health outcomes and preventable causes of premature death. Recent conceptualizations of alcohol dependence posit that the subjective experience of pain may be a significant contributing factor in the transition across the spectrum of alcohol use behavior. This narrative review summarizes the effects of alcohol at all levels of the pain system. The pain system includes nociceptors as sensory indicators of potentially dangerous stimuli and tissue damage (nociception), spinal circuits mediating defensive reflexes, and most importantly, the supraspinal circuits mediating nocifensive behaviors and the perception of pain. Although the functional importance of pain is to protect from injury and further or future damage, chronic pain may emerge despite the recovery from, and absence of, biological damage (i.e., in the absence of nociception). Like other biological perceptual systems, pain is a construction contingent on sensory information and a history of individual experiences (i.e., learning and memory). Neuroadaptations and brain plasticity underlying learning and memory and other basic physiological functions can also result in pathological conditions such as chronic pain and addiction. Moreover, the negative affective/emotional aspect of pain perception provides embodied and motivational components that may play a substantial role in the transition from alcohol use to dependence.

Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders?

BACKGROUND

Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS).

AIMS

A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed.

RESULTS AND DISCUSSION

Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs.

CONCLUSION

There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.

Words hurt: common and distinct neural substrates underlying nociceptive and semantic pain

Introduction

Recent studies have shown that processing semantic pain, such as words associated with physical pain, modulates pain perception and enhances activity in regions of the pain matrix. A direct comparison between activations due to noxious stimulation and processing of words conveying physical pain may clarify whether and to what extent the neural substrates of nociceptive pain are shared by semantic pain. Pain is triggered also by experiences of social exclusion, rejection or loss of significant others (the so-called social pain), therefore words expressing social pain may modulate pain perception similarly to what happens with words associated with physical pain. This event-related fMRI study aims to compare the brain activity related to perceiving nociceptive pain and that emerging from processing semantic pain, i.e., words related to either physical or social pain, in order to identify common and distinct neural substrates.

Methods

Thirty-four healthy women underwent two fMRI sessions each. In the Semantic session, participants were presented with positive words, negative pain-unrelated words, physical pain-related words, and social pain-related words. In the Nociceptive session, participants received cutaneous mechanical stimulations that could be either painful or not. During both sessions, participants were asked to rate the unpleasantness of each stimulus. Linguistic stimuli were also rated in terms of valence, arousal, pain relatedness, and pain intensity, immediately after the Semantic session.

Results

In the Nociceptive session, the 'nociceptive stimuli' vs. 'non-nociceptive stimuli' contrast revealed extensive activations in SI, SII, insula, cingulate cortex, thalamus, and dorsolateral prefrontal cortex. In the Semantic session, words associated with social pain, compared to negative pain-unrelated words, showed increased activity in most of the same areas, whereas words associated with physical pain, compared to negative pain-unrelated words, only activated the left supramarginal gyrus and partly the postcentral gyrus.

Discussion

Our results confirm that semantic pain partly shares the neural substrates of nociceptive pain. Specifically, social pain-related words activate a wide network of regions, mostly overlapping with those pertaining to the affective-motivational aspects of nociception, whereas physical pain-related words overlap with a small cluster including regions related to the sensory-discriminative aspects of nociception. However, most regions of overlap are differentially activated in different conditions.

Effects of an open-label placebo intervention on reactions to social exclusion in healthy adults: a randomized controlled trial

Social exclusion, that is being left out by others, can have adverse consequences for individuals' psychological well-being. Even short-term experiences of social exclusion strongly threaten basic psychological needs and cause so-called social pain. Prior research suggests an overlap between the experience of social and physical pain that, amongst others, is reflected by the effectiveness of physical pain treatments in alleviating social pain. Drawing upon these prior findings, we here explore whether open-label placebos, which have previously been found to be effective in reducing physical pain, can alleviate social pain following social exclusion. Seventy-four healthy participants were randomly assigned to one of four conditions in a 2 × 2 between-subjects design: First, they either received an open-label placebo intervention or no treatment. Second, they either experienced inclusion or exclusion by their co-players in the interactive ball-tossing game Cyberball. We find that excluded participants in the open-label placebo condition experienced significantly less hurt feelings compared to those in the control condition (Cohen's d = 0.77). There was no effect of treatment for need threat. The findings suggest new possibilities to alleviate social pain, which is of particular interest in the context of preventing destructive and maladaptive behaviors in situations where functional coping strategies are unavailable.

Endocannabinoid basis of personality-Insights from animal model of social behavior

Rationale: The endocannabinoid system is known to be involved in learning, memory, emotional processing and regulation of personality patterns. Here we assessed the endocannabinoid profile in the brains of mice with strong characteristics of social dominance and submissiveness. Methods: A lipidomics approach was employed to assess the endocannabinoidome in the brains of Dominant (Dom) and Submissive (Sub) mice. The endocannabinoid showing the greatest difference in concentration in the brain between the groups, docosatetraenoyl ethanolamine (DEA), was synthesized, and its effects on the physiological and behavioral responses of Dom and Sub mice were evaluated. mRNA expression of the endocannabinoid receptors and enzymes involved in PUFA biosynthesis was assessed using qRT-PCR. Results: Targeted LC/MS analysis revealed that long-chain polyunsaturated ethanolamides including arachidonoyl ethanolamide (AEA), DEA, docosatrienoyl ethanolamide (DTEA), eicosatrienoyl ethanolamide (ETEA), eicosapentaenoyl ethanolamide (EPEA) and docosahexaenoyl ethanolamide (DHEA) were higher in the Sub compared with the Dom mice. Untargeted LC/MS analysis showed that the parent fatty acids, docosatetraenoic (DA) and eicosapentaenoic (EPA), were higher in Sub vs. Dom. Gene expression analysis revealed increased mRNA expression of genes encoding the desaturase FADS2 and the elongase ELOVL5 in Sub mice compared with Dom mice. Acute DEA administration at the dose of 15 mg/kg produced antinociceptive and locomotion-inducing effects in Sub mice, but not in Dom mice. Subchronic treatment with DEA at the dose of 5 mg/kg augmented dominant behavior in wild-type ICR and Dom mice but not in Sub mice. Conclusion: This study suggests that the endocannabinoid system may play a role in the regulation of dominance and submissiveness, functional elements of social behavior and personality. While currently we have only scratched the surface, understanding the role of the endocannabinoid system in personality may help in revealing the mechanisms underlying the etiopathology of psychiatric disorders.

Breastfeeding at Any Cost? Adverse Effects of Breastfeeding Pain on Mother-Infant Behavior

Breast milk is considered the ideal infant nutrition, and medical organizations encourage breastfeeding worldwide. Moreover, breastfeeding is often perceived as a natural and spontaneous socio-biological process and one of the fundamental roles of new mothers. While breastfeeding is beneficial, little scientific consideration has been given to its potential psychological challenges. Here, we investigate the phenomenon of breastfeeding pain in mothers and its association with maternal and infant behavioral regulation. During the postpartum weeks, the mother-infant dyad can be considered one allostatic unit directed at infant regulation and development. We hypothesize that pain comprises an allostatic challenge for mothers and will thus impair the capacity for dyadic regulation. To test this, we recruited 71 mothers with varying levels of breastfeeding pain and videotaped them with their infants (2-35 weeks old) during spontaneous face-to-face interactions. We quantified the individual differences in dyadic regulation by behaviorally coding the second-by-second affective expressions for each mother and infant throughout their interactions. We tested the extent to which breastfeeding pain alters affect regulation during mother-infant interactions. We discovered that mothers with severe breastfeeding pain express less affective expressions and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Moreover, infants of mothers experiencing pain during breastfeeding express less affective expressions and more mother-directed gaze while interacting with their mothers than infants of mothers who are not in pain. This demonstrates that the allostatic challenge of maternal pain interferes with the behavioral regulation of both mothers and infants. Since the mother-infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can impact the dyad and thus potentially impact child development, bonding, and mother and infant well-being. The challenges of breastfeeding should be considered in addition to the nutritional advances.

Chronic pain as a blind spot in the diagnosis of a depressed society. On the implications of the connection between depression and chronic pain for interpretations of contemporary society

One popular description of current society is that it is a depressed society and medical evidence about depression’s prevalence may well make such an estimation plausible. However, such normative-critical assessments surrounding depression have to date usually operated with a one-sided understanding of depression. This understanding widely neglects the various ways depression manifests as well as its comorbidities. This becomes evident at the latest when considering one of depression’s most prominent and well-known comorbidities: chronic pain. Against this background, we aim in this article to substantiate our leading claim that the phenomenal interconnection between depression and chronic pain must be acknowledged in the global diagnosis of a depressive society. Thus, we argue here for a complementation of the dominant interpretation of a depressed society. This would support the overcoming of oversimplified images and estimations about depression in current society and further, help to recognize chronic pain properly on the larger scale of assessments that address society as a whole.

The neurobiology of social stress resulting from Racism: Implications for pain disparities among racialized minorities

Extant literature posits that humans experience two types of threat: physical threat and social threat. While describing pain as "physical" or "social" can be helpful for understanding pain origins (i.e., broken bone versus lost relationship), this dichotomy is largely artificial and not particularly helpful for understanding how the human brain experiences pain. One real world example of social exclusion and rejection that is threatening and likely to bring about significant stress is racism. Racism is a system of beliefs, practices, and policies that operates to disadvantage racialized minorities while providing advantage to those with historical power, particularly White people in the United States and most other Western nations. The objective of this Mini-Review is to present evidence in support of the argument that racism promotes physical pain in racialized minorities, which in turn promotes chronic pain disparities. First, we provide a theoretical framework describing how racism is a potent stressor that affects the health and well-being of racialized minorities. We will then address the neurobiological underpinnings linking racism to social threat, as well as that linking social threats and physical pain. Finally, we will discuss how the perception of social threat brought about by racism may undermine pain management efforts.

Psychological pain and suicidal behavior: A review

Despite accumulation of clinical research on risk factors for suicidal process, understanding of the mechanisms and pathways underlying the emergence of suicidal thoughts and their progression to acts is insufficient. The suicidal process has been conceptualized in multiple psychological theories that have aimed to shed light on the interplay of contributing factors. One of the central concepts included in both the cubic model of suicide and the three-step theory of suicide is psychological pain (mental pain or psychache). Over the two last decades, interest in psychological pain has increased considerably, particularly since the discovery of the complex link between the pain processing system and the neurobiology of suicide, and the putative antisuicidal effect of buprenorphine. Growing evidence supports the association between experiencing psychological pain and suicidal ideation and acts in both clinical and non-clinical samples. However, many questions related to the concept of psychological pain and its role in prediction of suicidal behavior remain to be answered in future research. In this narrative review, we have outlined the history of the concept, the definition of psychological pain, and the tools developed for its measurement, summarized the empirical research on psychological pain in relation to suicidal behavior, and suggested future directions for clinical research on psychological pain and suicidal behavior.

Gender discrimination facilitates fMRI responses and connectivity to thermal pain

Gender discrimination is a serious social issue that has been shown to increase negative consequences, especially in females when accompanied by acute or chronic pain. Experiencing social pain through discrimination can increase an individual's evaluation of evoked physical pain. However, few studies have explored the mechanism underlying how gender discrimination modulates brain responses when individuals experience physical pain evoked by noxious stimuli. In this study, we addressed this issue using a gender discrimination fMRI paradigm with thermal pain stimulation. We found that discrimination indeed affected participants' own behavioral self-evaluation of noxious stimuli. Discrimination-encoded brain activations were identified in the temporopolar cortex, while brain activations to thermal stimuli after viewing pictures of discrimination were found in the dorsal anterior cingulate cortex (dACC). Brain activations in the temporopolar cortex and the dACC were correlated. Furthermore, pain perception-specific functional connectivity of the dACC-SII in the cue stage and the dACC-frontal in the pain stage were identified, suggesting a facilitative effect of gender discrimination on females' experience of physical pain. Our results indicate that the dACC may play a central role in mediating the affective aspect of physical pain after experiencing discrimination. These findings provide novel insights into the underlying mechanism of how gender discrimination facilitates females' experience of physical pain.

The effects of long-term menstrual pain on pain empathy in women with primary dysmenorrhea

ABSTRACT

Primary dysmenorrhea (PDM) is not only a painful experience but also affects the psychological and affective states of women. Neuroimaging studies have revealed shared neural substrates for somatic and empathic pains in healthy subjects. However, little is known about the relationship between pain intensity and pain empathy in pain disorders. The cyclic nature of PDM makes it a unique model for investigating this issue during a patients' pain phase. To study how long-term pain modulates empathy for pain, T1-weighted magnetic resonance imaging scans were obtained in 39 PDM patients and 41 matched female healthy controls during menstruation. Subjects viewed static visual stimuli of the limbs submitted to painful and nonpainful stimulation to solicit empathy. The visual analogue scale for pain intensity and the Interpersonal Reactivity Index for empathic ability were also obtained. We found that women with PDM exhibited higher pain empathy compared with controls. The anterior insula and brain regions related to sensory discrimination with decreased gray matter volumes were not only shared but also acted as a mediator between pain intensity and pain empathy in PDM patients. In addition, the general linear modeling analysis revealed that long-term pain experience was a more important factor to pain empathy compared with pain intensity. This indicated that long-term pain may cause maladaptive brain structural plasticity, which may further affect psychological adjustment to bring patients more vivid pain when they witness suffering and distress in others.

Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals

Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

Association of Chronic Low Back Pain With Personal Space Regulation

Background: While most previous studies regarding patients with chronic low back pain (CLBP) mainly focused on pain, disability, psychological damage, and intervention measures, the effect of CLBP on personal space remains unclear. The study aimed to assess the personal space of patients with CLBP and healthy controls, explored the differences between the two groups, and examined whether pain, dysfunction, anxiety, and depression affected the personal space regulation. Methods: The cross-sectional study recruited 24 patients with CLBP and 24 healthy controls at Shanghai Shangti Orthopedic Hospital and Shanghai University of Sport, Shanghai, China, from December 2018 to January 2019. A stop-distance paradigm was applied to measure the comfortable and uncomfortable distance under four conditions. A self-rating anxiety scale (SAS) and a self-rating depression scale (SDS) were used to examine the anxiety and depression levels of all participants. The pain intensity and dysfunction in the CLBP group were evaluated by the numeric rating scale and Roland-Morris questionnaire (RMDQ), respectively. Results: When approaching another individual or when being approached, the interpersonal distance under all the conditions in the CLBP group significantly differed from that in the healthy control group with larger space distances (p < 0.01). Gender had a significant main effect on the regulation of personal space in patients with CLBP (p < 0.05). The average pain intensity, scores on RMDQ, SAS, and SDS had a significant positive correlation with the interpersonal distance under the Same or Opposite Gender condition (p < 0.05). Conclusion: People with CLBP show an atypical personal space behavior and indeed have a greater interpersonal distance to strangers. The higher the pain intensity, dysfunction, anxiety, and depression, the greater the interpersonal distance in patients with CLBP. In the future, the effect and underlying neural mechanisms of pain and negative emotions on social withdrawal in patients should be examined.

The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

This article provides a narrative review on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) through a psychosocial lens and examines how this impairment affects its sufferers during adolescence and adulthood, as well as how it impacts family caregivers and healthcare professionals' mental health. Since there has been a lack of investigation in the literature, the primary psychosocial stressor that this review focuses on is loneliness. As such, and in an attempt to help establish a theoretical framework regarding how loneliness may impact ME/CFS, loneliness is comprehensively reviewed, and its relation to chronic illness is described. We conclude by discussing a variety of coping strategies that may be employed by ME/CFS individuals to address their loneliness. Future directions and ways with which the literature may investigate loneliness and ME/CFS are discussed.

Impact Factors of Empathy in Mainland Chinese Youth

Empathy was investigated in 592 Mainland Chinese youth using the Interpersonal Reactivity Index. Participants’ empathy-related information covering demographic traits, emotional wellness, as well as academic and social problems were recorded. Results of Classification and Regression Tree (CART) analysis showed that emotional empathy, cognitive empathy, and empathy-related personal distress was impacted by inherited traits (e.g., sex), acquired traits (e.g., study major), and a combination of both aspects, respectively. Moreover, empathy was found to be higher in youth in a vulnerable social position (i.e., outlander, female, and ethnic minority) than those in a dominant one (i.e., local, male, and ethnic majority). It was also found that personal distress, rather than empathy, was significantly correlated with academic, social, and emotional problems in the youth cohort. Hence, the current study provided an innovative observation of the relationships between empathy, personal distress, ethnicity, social vulnerability, wellness, study major, and other key characteristics in Mainland Chinese youth.