Positive interpretation bias predicts well-being in medical interns

Transitioning to college: Testing cognitive bias modification for interpretations as an inoculation tool for social anxiety in college first-years

BACKGROUND AND OBJECTIVES

Reducing social anxiety development among incoming college students may improve college adjustment and mental health outcomes. This study tested whether cognitive bias modification for interpretations (CBM-I) reduces social anxiety and increases adjustment during the transition to college, and whether changes in outcomes would be mediated by changes in interpretation biases.

METHODS

Participants (N = 73) were randomly assigned to a 3-session weekly CBM-I condition or symptom tracking (ST) control condition. Multilevel models were used to estimate within-person trajectories from baseline to one week post-intervention and to test whether trajectories differed by condition.

RESULTS

Those in the CBM-I condition (vs. ST) reported higher increases in social adjustment across time. There were not significant differences between conditions for changes in social anxiety, academic adjustment, and personal adjustment. CBM-I was indirectly linked to improvements in outcome variables via more adaptive interpretation biases.

LIMITATIONS

CBM-I was administered in a laboratory setting, requiring more resources than some computerized interventions.

CONCLUSIONS

Data tentatively support CBM-I for first-year students to increase social adjustment. Further, mediation findings provide support for targeting interpretation biases to improve social anxiety and adjustment outcomes. Yet, CBM-I did not outperform ST in improving social anxiety symptoms or other areas of college adjustment, and effect sizes were small, suggesting that more work is needed to amplify the potential of CBM-I as a therapeutic tool.

The role of trait reappraisal in response to emotional ambiguity: A systematic review and meta-analysis

Individuals exhibit a systematic valence bias-a specific form of interpretation bias-in response to emotional ambiguity. Accumulating evidence suggests most people initially respond to emotional ambiguity negatively and differ only in subsequent responses. We hypothesized that trait-level cognitive reappraisal-an emotion regulation strategy involving the reinterpretation of affective meaning of stimuli-might explain individual differences in valence bias. To answer this question, we conducted a random-effects meta-analysis of 14 effect sizes from 13 prior studies (n = 2,086), identified via Google Scholar searches. We excluded studies (a) in languages other than English, (b) from non-peer-reviewed sources, or (c) nonempirical sources. We included studies with (a) the Emotion Regulation Questionnaire, (b) a putative measure of valence bias prior to any study-specific manipulations, and (c) adult human participants (i.e., 17+). Supporting our prediction, we found individuals with higher trait reappraisal exhibited a less negative bias (r = -.18, z = -4.04, p < .001), whereas there was a smaller, opposite effect for trait expressive suppression (r = .10, z = 2.14, p = .03). The effects did, however, vary across tasks with stronger effects observed among studies using the scrambled sentences task compared to the valence bias task. Although trait reappraisal accounted for only a small amount of variance, reappraisal may be one mechanism contributing to variability in response to ambiguity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Child Maltreatment as a Risk Factor for Rejection Sensitivity: A Three-Level Meta-Analytic Review

Theoretical and empirical evidence has suggested that child maltreatment victimization is associated with rejection sensitivity. However, empirical evidence on this association is inconsistent. Therefore, this meta-analysis aimed to examine the overall association between child maltreatment and rejection sensitivity, and to investigate variables that may affect the strength of this association. Studies eligible for inclusion were searched in the databases: Web of Science, Science Direct, PubMed, MEDLINE, and China National Knowledge Infrastructure after which relevant studies were coded. Studies were synthesized in advanced three-level meta-analytic models in R. A total of 16 studies (N = 5,335 participants) yielding 41 effect sizes were included. Results showed that child maltreatment is significantly and positively related to rejection sensitivity (mean r = 0.230; p < .001), and to a small extent. Furthermore, this association is stronger for emotional abuse (r = 0.275) than for physical abuse (r = 0.157). It is not affected by the mean age and gender distribution of primary study samples nor by sample type (community sample versus clinical sample). It is concluded that child maltreatment is a risk factor for developing rejection sensitivity later in life. Therefore, interventions for rejection sensitivity should consider potential trauma resulting from prior child maltreatment experiences.

Negative and positive interpretations of emotionally neutral situations modulate the desire to eat personally craved foods

Emotions play an important role in modulating food craving. Previous studies demonstrated that exposure to negative or positive stimuli can subsequently influence the desire to eat. However, in many daily situations, individuals self-generate their emotions, for example, by interpreting emotionally-neutral situations as positive or negative. So far, no studies have examined if and how positive and negative interpretations of emotionally-neutral situations modulate food craving. In this study, 65 healthy participants were asked to interpret emotionally-neutral images negatively or positively or observe the images naturally. Subsequently, participants rated their state negative/positive affect and their desire to eat their personally craved foods. The results demonstrate a lower desire to eat craved foods after negative interpretations and a higher desire to eat after positive interpretations, compared to an observe-naturally condition. Additionally, the impact of emotional interpretations on the desire to eat was mediated by participants' state negative/positive affect. These findings suggest that self-generated emotion as a result of negative/positive interpretations plays a significant role in modulating food craving. The results highlight the potential of modifying affective interpretations for the treatment of disorders that are characterized by both dysregulated food craving and emotion.

Dissociation of Implicit and Explicit Interpretation Bias: The Role of Depressive Symptoms and Negative Cognitive Schemata

A negative interpretation bias appears to depend on several depression-related state and trait characteristics, most notably depressive symptoms, negative mood, and negative cognitive schemas. While empirical findings for explicitly assessed interpretation bias are rather consistent, implicit measures have revealed heterogeneous results. In this context, we present two studies investigating the relationship between implicit and explicit interpretation bias and depression- and anxiety-related state and trait variables. In the first study, we conducted an implicit ambiguous cue-conditioning task (ACCT) with 113 young, healthy individuals. In the second study, we utilized an explicit ambiguous social situations task (DUCTUS) with 113 young, healthy individuals. Additionally, a subsample of 46 participants completed both the ACCT and DUCTUS tasks to directly relate the two bias scores obtained from the implicit and explicit assessment methods, respectively. In the first study, regression analysis revealed no significant predictors for the implicit interpretation bias. However, in the second study, the explicit negative interpretation bias was significantly predicted by female gender, depressive symptoms, and dysfunctional cognitive schemas. For the subsample that completed both tasks, we observed no significant correlation between the two bias scores obtained from the ACCT and DUCTUS. These results suggest that implicit and explicit interpretation biases are differently associated with depression-related trait and state characteristics, indicating that they represent different aspects of biased information processing.

'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda

OBJECTIVE

Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors' internship experiences in Kenya and Uganda.

METHODS

Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data.

FINDINGS

Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being 'treated like we are nobody'.

CONCLUSION

We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors' well-being and provide standardised supervision, support systems and conducive learning environments.

Neural representations of ambiguous affective stimuli and resilience to anxiety in emerging adults

The tendency to interpret ambiguous stimuli as threatening has been associated with a range of anxiety disorders. Responses to ambiguity may be particularly relevant to mental health during the transition from adolescence to adulthood ("emerging adulthood"), when individuals encounter unfamiliar challenges and navigate novel social situations. However, it remains unclear whether neural representations of ambiguity relate to risk for anxiety. The present study sought to examine whether multivariate representations of ambiguity - and their similarity to representations of threat - relate to appraisals of ambiguity or anxiety in a sample of emerging adults. Participants (N = 41) viewed threatening (angry), nonthreatening (happy), and ambiguous (surprised) facial stimuli while undergoing fMRI. Outside of the scanner, participants were presented with the same stimuli and categorized the ambiguous faces as positive or negative. Using representational similarity analyses (RSA), we investigated whether the degree of pattern similarity in responses to ambiguous, nonthreatening, and threatening faces within the amygdala related to appraisals of ambiguous stimuli and anxiety symptomatology. We found that individuals who evidenced greater similarity (i.e., less differentiation) in neural representations of ambiguous and nonthreatening faces within the left amygdala reported lower concurrent anxiety. Additionally, trial-level pattern similarity predicted subsequent appraisals of ambiguous stimuli. These findings provide insight into how neural representations of ambiguity relate to risk or resilience for the development of anxiety.

Early Life Maltreatment and Adolescent Interpretations of Ambiguous Social Situations: Investigating Interpersonal Cognitions and Emotional Symptoms

In the general population, negative interpretations of social situations have been associated with risk of developing emotional disorders such as anxiety and depression. Given that childhood maltreatment poses risk for later emotional disorders, this study examined whether interpersonal cognitive style differentiated maltreated adolescents from their non-maltreated peers and correlated with emotional symptoms across each group. Forty-seven maltreated and 28 non-maltreated adolescents were recruited from New South Wales, Australia to complete a battery of questionnaires that assessed interpersonal cognitions and levels of anxiety and depression. Comparable endorsement of threatening interpretations of social situations between maltreated adolescents and their non-maltreated peers across measures was found. Furthermore, an association between anxiety and depressive symptoms and interpretation bias was found within the non-maltreatment group but not the maltreated group. Unlike general population samples, negative cognitions do not associate with emotional symptoms in victims of early maltreatment. More research is needed to investigate the cognitive factors maintaining emotional symptoms in adolescent victims of maltreatment.

Think again: the role of reappraisal in reducing negative valence bias

Stimuli such as surprised faces are ambiguous in that they are associated with both positive and negative outcomes. Interestingly, people differ reliably in whether they evaluate these and other ambiguous stimuli as positive or negative, and we have argued that a positive evaluation relies in part on a biasing of the appraisal processes via reappraisal. To further test this idea, we conducted two studies to evaluate whether increasing the cognitive accessibility of reappraisal through a brief emotion regulation task would lead to an increase in positive evaluations of ambiguity. Supporting this prediction, we demonstrated that cuing reappraisal, but not in three other forms of emotion regulation (Study 1a-d; n = 120), increased positive evaluations of ambiguous faces. In a sign of robustness, we also found that the effect of reappraisal generalised from ambiguous faces to ambiguous scenes (Study 2; n = 34). Collectively, these findings suggest that reappraisal may play a key role in determining responses to ambiguous stimuli. We discuss these findings in the context of affective flexibility, and suggest that valence bias (i.e. the tendency to evaluate ambiguity more positively or negatively) represents a novel approach to measuring implicit emotion regulation.

The Relationship between Mindfulness and Social Adaptation among Migrant Children in China: The Sequential Mediating Effect of Self-Esteem and Resilience

Social adaptation of migrant children is not only related to the physical and mental health and development of individuals, but also reflects the level of urban social integration and stable development. Mindfulness has a protective effect on individual social adaptation. Self-esteem and resilience were found to be positively associated with mindfulness and social adaptation. Based on the Positive Youth Development Perspective, this study aimed to explore whether self-esteem and resilience sequentially mediated the associations among mindfulness and social adaptation. A total of 526 migrant children were assessed with the questionnaires regarding mindfulness, self-esteem, resilience, and social adaptation. The results indicated that mindfulness was positively associated with social adaptation of migrant children. Self-esteem and resilience played the sequential mediating roles between mindfulness and social adaptation. The present study revealed the influence and mechanism of mindfulness on social adaptation and provided some guidance for the intervention programs to promote migrant children's adaptability.

Machine learning models for predicting risk of depression in Korean college students: Identifying family and individual factors

Background

Depression is one of the most prevalent mental illnesses among college students worldwide. Using the family triad dataset, this study investigated machine learning (ML) models to predict the risk of depression in college students and identify important family and individual factors.

Methods

This study predicted college students at risk of depression and identified significant family and individual factors in 171 family data (171 fathers, mothers, and college students). The prediction accuracy of three ML models, sparse logistic regression (SLR), support vector machine (SVM), and random forest (RF), was compared.

Results

The three ML models showed excellent prediction capabilities. The RF model showed the best performance. It revealed five significant factors responsible for depression: self-perceived mental health of college students, neuroticism, fearful-avoidant attachment, family cohesion, and mother's depression. Additionally, the logistic regression model identified five factors responsible for depression: the severity of cancer in the father, the severity of respiratory diseases in the mother, the self-perceived mental health of college students, conscientiousness, and neuroticism.

Discussion

These findings demonstrated the ability of ML models to accurately predict the risk of depression and identify family and individual factors related to depression among Korean college students. With recent developments and ML applications, our study can improve intelligent mental healthcare systems to detect early depressive symptoms and increase access to mental health services.

Attention and interpretation cognitive bias change: A systematic review and meta-analysis of bias modification paradigms

This systematic review and meta-analysis examines the effect of Cognitive Bias Modification for attention (CBM-A) and interpretation (CBM-I) on reducing the targeted biases and investigates moderators of each approach. PsycINFO, PsychArticles, and PubMED databases were searched for randomized-controlled studies published before March 2020 with pre- and post-CBM cognitive bias outcome measures, resulting in 91 CBM-A (n = 5914 individuals) and 70 CBM-I samples (n = 4802 individuals). Random-effects models and Hedge's g calculation showed significant medium overall effects of bias reduction with moderate to high heterogeneity (CBM-A g = 0.49 [0.36, 0.64], I² = 85.19%; CBM-I g = 0.58 [0.48, 0.68], I² = 70.92%). Effect sizes did not differ between approaches and remained significant after trim-and-fill adjustment for possible publication bias. Moderator variables were investigated with meta-regression and subgroup analyses. Participant age, symptom type, control condition and number of trials moderated CBM-A; student and clinical status moderated CBM-I effect size. Results support attention and interpretation modification in controlled laboratory and variable (online) training settings for non-clinical and clinical samples across various symptom types (anxiety, depression, substance use, eating disorders). Further empirical evidence is necessary to determine optimal sample and methodological combinations most strongly associated with adaptive behavioral outcomes.

Exploring the experiences and expectations of pharmacist interns in large general hospitals in China: from the perspective of interns

BACKGROUND

Hospital-based pharmacy internship (HBPI) is critical for the transition from "pharmacy students" to "professional pharmacists". This study explores the pharmacist interns' experiences and expectations for HBPI from their personal experiences intending to provide references for future hospital pharmacy education reform and policy development.

METHODS

This is a multicenter qualitative study applying focus group discussions. Pharmacist interns were invited as participants from large teaching hospitals in Henan, China. A thematic analysis was conducted to qualitatively analyze this data. Nvivo 12 was utilized for data management and processing.

RESULTS

Three focus group discussions were conducted, involving 16 interns as participants. Three themes were summarized regarding interns' expectations and experiences: (1) positive experiences of the HBPI; (2) negative experiences of the HBPI; (3) expectations and suggestions for the HBPI.

CONCLUSION

This study finds that the HBPI improves the professional knowledge, professional skills, and core competencies of interns. Therefore, the HBPI is an important preparation and transition stage for pharmacy students. However, the current pharmacy internship in China still has imperfections such as the insufficient ability of clinical teachers, unreasonable internship models, and unscientific internship content.

Effects of college students' mindfulness on depression symptoms during the epidemic prevention and control period: The mediating effect of psychological resilience

Depression symptoms significantly impact college students' mental health, particularly during the "closed management" period during the spread of COVID-19. Exploring the mechanism that affects college students' depression symptoms can help alleviate the impact of closed management policies on individual mental health and improve their mental health level. The onset of the COVID-19 pandemic resulted in the normalization of epidemic prevention and control in China and the implementation of the dynamic zero-COVID policy. This study used the Five-Factor Mindfulness Questionnaire-Short Form, Psychological Resilience Scale, and Beck Depression Scale to investigate the mindfulness, psychological resilience, and depression symptoms of 1,062 students under closed management conditions at Northwest Normal University. The mindfulness, psychological resilience, and depression status of students in closed management were investigated using an online questionnaire survey. Eight hundred and ten college students (M _age = 20.43, SD = 1.67, range = 17-30) were selected to test the model using the structural equation model and bootstrap method. The results showed that the gender differences in mindfulness and psychological resilience were not significant. Gender differences in depression symptoms were significant, and depression symptoms in men were significantly higher than in women. Grade differences in resilience, mindfulness, and depression levels were not significant. Thus, psychological resilience is negatively associated with depressive symptoms. Psychological resilience plays a mediating role between mindfulness and depressive symptoms. This study provides reference and inspiration for improving college students' mental health under epidemic prevention and control circumstances.

The effect of self-referential processing on anxiety in response to naturalistic and laboratory stressors

Although stressful life events increase risk for symptoms of Generalised Anxiety Disorder (GAD), we know little about mechanisms that increase GAD symptoms during times of stress. Despite evidence that self-referential processing contributes to other forms of psychopathology, namely depression, it is unknown whether self-referential processing also contributes to symptoms of GAD. Thus, we examined the association of self-referential processing with GAD symptoms in response to a naturalistic stressor (Study 1; n=135) and with anxiety-tension in response to a laboratory stressor (Study 2; n=56). In Study 1, participants completed the self-referential encoding task (SRET) in their initial weeks of university, and we assessed GAD symptoms four times across the semester. In Study 2, participants completed the SRET immediately before a laboratory stressor, and we assessed moment-to-moment changes in anxiety-tension. Greater negatively biased self-referential processing was associated with higher GAD symptoms at the start of university and greater reactivity to the laboratory stressor. In contrast, greater positively biased self-referential processing served as a protective factor associated with greater decline in symptoms over time. This study is the first to demonstrate that there are valence-specific effects of self-referential processing on anxiety, suggesting that self-referential processing may be relevant to GAD.

Outbreak of COVID-19 altered the relationship between memory bias and depressive degree in nonclinical depression

The outbreak of the novel coronavirus disease 2019 (COVID-19) has increased concern about people's mental health under such serious stressful situation, especially depressive symptoms. Cognitive biases have been related to depression degree in previous studies. Here, we used behavioral and brain imaging analysis, to determine if and how the COVID-19 pandemic affects the relationship between current cognitive biases and future depression degree and the underlying neural basis in a nonclinical depressed population. An out-expectation result showed that a more negative memory bias was associated with a greater decrease in future depressive indices in nonclinical depressed participants during the COVID-19 pandemic, which might be due to decreased social stress. These data enhance our understanding of how the depressive degree of nonclinical depressed populations will change during the COVID-19 pandemic and also provide support for social distancing policies from a psychological perspective.

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We collected depressive degree before and during the COVID-19 pandemic

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Depressive degree negatively correlated with memory bias during the pandemic

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Reduced social stress during the pandemic might lead to the altered relationship

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Results provide extra support for social distancing policies during the pandemic

Is Electronic Multitasking Always Viewed as a Counterproductive Meeting Behavior? Understanding the Nature of the Secondary Task

This project explored social evaluations of electronic multitasking during work meetings, including factors that may affect whether it is seen as a counterproductive meeting behavior. We used an experimental vignette design to test whether social evaluations (norm violating, agency, and communalism) of a hypothetical coworker's electronic multitasking differed by whether the secondary task was relevant to the meeting (Study 1; N = 274) or ambiguous (Study 2; N = 188). Observers evaluated task-irrelevant multitasking as more of a norm violation and less communal compared to task-relevant multitasking, and work-related tasks were evaluated as more agentic than nonwork-related tasks. Ambiguous tasks were also rated as more agentic than task-irrelevant multitasking. Taken together, our results show that the nature of the secondary task reduces negative perceptions of coworkers' electronic multitasking behavior during meetings. However, electronic multitasking for any purpose, even if relevant, was generally judged negatively consistent with expectations for a counterproductive meeting behavior.

Tolerance of ambiguity and psychological well-being in medical training: A systematic review

CONTEXT

The prevalence of stress, burnout and mental health disorders in medical students and doctors is high. It has been proposed that there may be an association between levels of tolerance of ambiguity (ie an ability to tolerate a lack of reliable, credible or adequate information) in clinical work and psychological well-being within this population. The aims of this systematic review were: (i) to assess the nature and extent of the literature available, in order to determine if there is an association, and (ii) to develop a conceptual model proposing possible mechanisms to underpin any association, in order to inform subsequent research.

METHODS

MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched for articles published from inception to September 2018. Additional literature was identified by searching the reference lists of included articles, forward searches of included articles, hand searches of key journals and a grey literature search. Of the 671 studies identified, 11 met the inclusion criteria. A qualitative synthesis of included studies was performed.

RESULTS

All 11 included studies reported an association between a lower level of tolerance of ambiguity or uncertainty and reduced psychological well-being. Included studies were heterogeneous in terms of population and measurement approach, and were often of low methodological quality. Subsets of items from previously developed scales were often used without sufficient consideration of the impact of new combinations of items on scale validity. Similar scales were also scored inconsistently between studies, making comparison difficult.

CONCLUSIONS

There appears to be an association between tolerance of ambiguity and psychological well-being. This provides new opportunities to understand and prevent the development of stress, burnout and mental health disorders in medical students and doctors. The conceptual model developed provides a framework for future research, which we hope will prevent wasted research effort through duplication and promote higher methodological quality.

Biased cognition in East Asian and Western cultures

The majority of cognitive bias research has been conducted in Western cultures. We examined cross-cultural differences in cognitive biases, comparing Westerners' and East Asians' performance and acculturation following migration to the opposite culture. Two local (UK, Hong Kong) and four migrant (short-term and long-term migrants to each culture) samples completed culturally validated tasks measuring attentional and interpretation bias. Hong Kong residents were more positively biased than people living in the UK on several measures, consistent with the lower prevalence of psychological disorders in East Asia. Migrants to the UK had reduced positive biases on some tasks, while migrants to Hong Kong were more positive, compared to their respective home counterparts, consistent with acculturation in attention and interpretation biases. These data illustrate the importance of cultural validation of findings and, if replicated, would have implications for the mental health and well-being of migrants.

Looking on the bright side and seeing it vividly: interpretation bias and involuntary mental imagery are related to risk for bipolar disorder

BACKGROUND

Involuntary mental imagery is elevated among people with bipolar disorder, and has been shown to shape biases in interpretation of ambiguous information. However, it is not clear whether biases in interpretation of ambiguous scenarios can be observed in those at risk for bipolar disorder, or whether involuntary imagery is related to such a bias.

AIMS

In the present study, we extended a prominent model of bipolar cognition to an at-risk sample. We specifically tested whether positive interpretation bias and involuntary mental imagery are linked to a greater risk of bipolar disorder.

METHOD

Young adults (N = 169) completed measures of risk for bipolar disorder (the Hypomanic Personality Scale [HPS]), interpretation bias, and involuntary mental imagery.

RESULTS

Higher scores on the HPS were significantly correlated with more positive interpretations of ambiguous scenarios (β = 0.29, p <. 01) and more frequent involuntary mental imagery (β = 0.22, p < .01). There was no evidence of an interaction between interpretation bias and mental imagery in predicting HPS score, β = .04, p = .62.

CONCLUSIONS

Further research is warranted to determine if intrusive imagery or interpretation bias influence the development of bipolar disorder over time in those at risk.

The impact of students with left-behind experiences on childhood: The relationship between negative life events and depression among college students in China

BACKGROUND

The number of left-behind children in rural China has increased dramatically over the last decade. It is reported that about 21.88% of child population with an estimated number of 61 million are left-behind children whose parents leave them to work in cities. We conducted a cross-sectional study to explore the impacts of left-behind experience (LBE) on college students' depression and other influencing factors.

AIM

This study discusses the mediation effect of self-esteem together with psychological resilience on college students with depression and negative life events of left-behind. The study also discusses the regulation effect of LBE.

METHODS

A total of 788 college students were selected from three universities in Sichuan and Chongqing (367 with LBEs, 421 without LBEs). Adolescent Self-Rating Life Events Check List (ASLEC), Self-Esteem Scale (SES), Resilience Scale of Chinese Adolescent (RSCA) and Self-Rating Depression Scale (SDS) were used to measure the negative life events, self-esteem, psychological resilience and depression, respectively. Bootstrap program was used to test the mediation effect, and multiple-group analysis was used to examine the regulation effect for LBE.

RESULTS

Scores of ASLEC for the college students with LBEs were higher than those without LBEs (8.59 ± 3.57) vs (7.06 ± 3.38), p < .001). The scores of LBE, ASLEC and SDS were positively correlated with the college students with LBEs ( r = .21 to .29, p < .01), while the scores of RSCA and SES were negatively correlated ( r = -.30 to -.59, p < .01). The mediation effect of college students' self-esteem and psychological resilience between negative life events and depression was significant (mediating effect = .08, .13, .07; p < .01). Thus, the college students' self-esteem and psychological resilience on negative life events had strong mediation effect on depression. The test of Bootstrap showed that the mediation effect of self-esteem and psychological resilience was significant (95% confidence interval (CI) = [0.04-0.76]). The LBE had regulation effect on college students' self-esteem and psychological resilience. (The constraint model fitting degree of variation is Δχ² = 2,120.68, Δ df = 8, p < .001.) The self-esteem and psychological resilience of college students with LBEs can be used to mediate the relation between negative life events and depression, whereas those without LBEs cannot.

CONCLUSION

Self-esteem and psychological resilience fully mediates college students' negative life events and depression, which is regulated by their previous LBEs.

A Systematic Review of Experimental Paradigms for Exploring Biased Interpretation of Ambiguous Information with Emotional and Neutral Associations

Interpretation biases have been extensively explored in a range of populations, including patients with anxiety and depressive disorders where they have been argued to influence the onset and maintenance of such conditions. Other populations in which interpretation biases have been explored include patients with chronic pain, anorexia nervosa, and alcohol dependency among others, although this literature is more limited. In this research, stimuli with threatening/emotional and neutral meanings are presented, with participant responses indicative of ambiguity resolution. A large number of paradigms have been designed and implemented in the exploration of interpretation biases, some varying in minor features only. This article provides a review of experimental paradigms available for exploring interpretation biases, with the aim to stimulate and inform the design of future research exploring cognitive biases across a range of populations. A systematic search of the experimental literature was conducted in Medline, PsychINFO, Web of Science, CINAHL, and Cochrane Library databases. Search terms were information, stimuli, and ambiguous intersected with the terms interpretation and bias*. Forty-five paradigms were found, categorized into those using ambiguous words, ambiguous images, and ambiguous scenarios. The key features, strengths and limitations of the paradigms identified are discussed.

Seeing light at the end of the tunnel: Positive prospective mental imagery and optimism in depression

Optimism is associated with positive outcomes across many health domains, from cardiovascular disease to depression. However, we know little about cognitive processes underlying optimism in psychopathology. The present study tested whether the ability to vividly imagine positive events in one's future was associated with dispositional optimism in a sample of depressed adults. Cross-sectional and longitudinal analyses were conducted, using baseline (all participants, N=150) and follow-up data (participants in the control condition only, N=63) from a clinical trial (Blackwell et al., 2015). Vividness of positive prospective imagery, assessed on a laboratory-administered task at baseline, was significantly associated with both current optimism levels at baseline and future (seven months later) optimism levels, including when controlling for potential confounds. Even when depressed, those individuals able to envision a brighter future were more optimistic, and regained optimism more quickly over time, than those less able to do so at baseline. Strategies to increase the vividness of positive prospective imagery may aid development of mental health interventions to boost optimism.

Resilience and Cognitive Bias in Chinese Male Medical Freshmen

BACKGROUND

Psychological resilience has become a hot issue in positive psychology research. However, little is known about cognitive bias difference of individuals with different resilience levels. This study aimed to explore the characteristics of cognitive bias and its role in Chinese medical freshmen with different resilience levels.

METHODS

312 Chinese medical freshmen were surveyed by the Chinese version of Connor-Davidson Resilience Scale, 92 of whom were, respectively, allocated into high (n = 46) and low (n = 46) resilient group to complete computerized tests using an attentional shifting task and an emotional picture recognition task.

RESULTS

All participants had the highest recognition accuracy toward negative pictures compared to neutral and positive ones. By comparison, it was found that the high-resilient group had a longer recognition response time toward positive emotional pictures, but a shorter response time toward negative emotional pictures, while the low-resilient group had a longer response time toward negative emotional pictures.

CONCLUSION

This study pointed to the association between resilience and cognitive bias. Medical freshmen with different resilience levels showed significant differences in the cognitive bias toward emotional pictures, suggesting that reducing negative cognitive bias and promoting positive cognitive bias could be important targets to increase resilience.

Mental Imagery-Based Training to Modify Mood and Cognitive Bias in Adolescents: Effects of Valence and Perspective

Mental imagery has a powerful impact on emotion and cognitive processing in adults, and is implicated in emotional disorders. Research suggests the perspective adopted in mental imagery modulates its emotional impact. However, little is known about the impact of mental imagery in adolescence, despite adolescence being the key time for the onset of emotional dysfunction. We administered computerised positive versus mixed valence picture-word mental imagery training to male adolescent participants (N = 60, aged 11–16 years) across separate field and observer perspective sessions. Positive mood increased more following positive than mixed imagery; pleasantness ratings of ambiguous pictures increased following positive versus mixed imagery generated from field but not observer perspective; negative interpretation bias on a novel scrambled sentences task was smaller following positive than mixed imagery particularly when imagery was generated from field perspective. These findings suggest positive mental imagery generation alters mood and cognition in male adolescents, with the latter moderated by imagery perspective. Identifying key components of such training, such as imagery perspective, extends understanding of the relationship between mental imagery, mood, and cognition in adolescence.

Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications

Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.

Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis

IMPORTANCE

Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies.

OBJECTIVE

To provide a summary estimate of depression or depressive symptom prevalence among resident physicians.

DATA SOURCES AND STUDY SELECTION

Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms.

DATA EXTRACTION AND SYNTHESIS

Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.

MAIN OUTCOMES AND MEASURES

Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire.

RESULTS

Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.

CONCLUSIONS AND RELEVANCE

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.