Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach

A comprehensive investigation of comorbidities of prolonged grief disorder in a bereaved inpatient psychiatric sample

Prolonged Grief Disorder (PGD) was recently added to ICD-11 and DSM-5-TR. Depression and Posttraumatic Stress Disorder (PTSD) are frequent comorbidities, but findings regarding comorbid somatoform disorder and personality disorders remain mixed and studies with severely impaired patients are scarce. It was therefore the objective of the present study to examine comorbidities of PGD in a bereaved inpatient psychiatric sample. We assessed N = 101 bereaved inpatients in a psychiatric hospital with clinical interviews and self-report questionnaires. We calculated differences between patients with and without a PGD-diagnosis in number and type of comorbid disorders as well as associations between the severity of PGD and comorbid disorders. On average, patients had 2.53 comorbid psychiatric diagnoses. Patients with and without a PGD-diagnosis did not differ in their number of comorbid diagnoses, and there was no association between number of comorbid diagnoses and PGD-severity. However, patients with PGD, had significantly more comorbid diagnoses belonging to neurotic-, stress-related and somatoform disorders of the ICD-10. Patients with PGDICD-11 also had significantly higher scores in self-reported depressive, PTSD-, and somatoform symptoms, as well as the negative affectivity personality domain than those without a PGD diagnosis. To the best of our knowledge, this is the first study to provide insights into comorbidities of PGD in a bereaved inpatient psychiatric sample. It highlights the importance of considering PGD symptoms as part of the complaints of bereaved patients to achieve a tailored treatment approach. Future longitudinal studies are needed to unveil relationships between pre-existing mental disorders and PGD.

Maladaptive Personality Characteristics, Coping and Situational Factors Predict Symptoms of Complicated Grief and Health Difficulties

Grief responses range from minimal changes in functioning to debilitating, prolonged, complicated grief. The objective of the current study was to clarify the relationship between maladaptive personality characteristics, coping and situational factors associated with symptoms of complicated grief and health difficulties among bereaved individuals who had lost a loved one within the past six months to two years (N = 304; 59% male; M age = 33.49, SD = 9.98, range 20-81). Situational risk factors, coping (self-distancing, denial, substance use, positive reframing, acceptance, religion, self-blame, behavioral disengagement, venting and humor) and maladaptive personality traits significantly predicted either symptoms of complicated grief or health difficulties. Coping strategies partially mediated the relationship between maladaptive personality traits and symptoms of complicated grief and health difficulties. Overall, these findings highlight the importance of maladaptive personality traits and coping strategies in the conceptualization of complicated grief and should be a greater focus of clinical intervention.

A network analysis on biopsychosocial factors and pain-related outcomes assessed during a COVID-19 lockdown

Psychological stress, social isolation, physical inactivity, and reduced access to care during lockdowns throughout a pandemic negatively impact pain and function. In the context of the first COVID-19 lockdown in Spain, we aimed to investigate how different biopsychosocial factors influence chiropractic patients' pain-related outcomes and vice-versa. A total of 648 chiropractic patients completed online questionnaires including variables from the following categories: demographics, pain outcomes, pain beliefs, impact of the COVID-19 pandemic, stress/anxiety and self-efficacy. Twenty-eight variables were considered in a cross-sectional network analysis to examine bidirectional associations between biopsychosocial factors and pain outcomes. Subgroup analyses were conducted to estimate differences according to gender and symptom duration. The greatest associations were observed between pain duration and pain evolution during lockdown. Participants' age, pain symptoms' evolution during lockdown, and generalized anxiety were the variables with the strongest influence over the whole network. Negative emotions evoked by the pandemic were indirectly associated with pain outcomes, possibly via pain catastrophizing. The network structure of patients reporting acute pain showed important differences when compared to patients with chronic pain. These findings will contribute to identify which factors explain the deleterious effects of both the pandemic and the restrictions on patients living with pain.

Understanding the psychological mechanisms of return to sports readiness after anterior cruciate ligament reconstruction

PURPOSE

The psychological response to an Anterior Cruciate Ligament (ACL) injury is significant and can negatively impact return to sports outcomes. This study aimed to quantify the association between factors associated with return to sport using network analysis.

METHODS

441 participants who underwent primary ACL reconstruction. The 12-item ACL Return to Sport after Injury (ACL-RSI) scale was administered to all participants 12 months after surgery. Three network analyses were used to quantify the adjusted correlations between the 12 items of the ACL-RSI scale, and to determine the centrality indices of each item (i.e., the degree of connection with other items in the network). Further subgroup network analyses were conducted for those who had (n = 115) and had not returned (n = 326) to their pre-injury level of sport.

RESULTS

The greatest adjusted correlation was between Q7 and Q9 (fear of re-injury and afraid of accidentally injuring knee) of the ACL-RSI (group 0.48 (95%CI [0.40 to 0.57])) across all three networks. The most important item in the network was Q12 (relaxed about sport) across all three networks. Individuals who did return to sport had greater Strength centrality for Q8 (confidence in knee, P = 0.014) compared to those who did not return to sport.

CONCLUSION

Fear of re-injury and being relaxed about playing sport were the two most important nodes in the network models that describe the return to sport readiness. The importance of knee confidence at influencing psychological readiness was greater in athletes who did return to sport compared to those who did not. Our findings provide candidate therapeutic targets that could inform future interventions designed to optimize return to sport rates in athletes post ACL reconstruction.

Understanding how individualised physiotherapy or advice altered different elements of disability for people with low back pain using network analysis

PURPOSE

The Oswestry Disability Index (ODI) is a common aggregate measure of disability for people with Low Back Pain (LBP). Scores on individual items and the relationship between items of the ODI may help understand the complexity of low back disorders and their response to treatment. In this study, we present a network analysis to explore how individualised physiotherapy or advice might influence individual items of the ODI, and the relationship between those items, at different time points for people with LBP.

METHODS

Data from a randomised controlled trial (n = 300) comparing individualised physiotherapy versus advice for low back pain were used. A network analysis was performed at baseline, 5, 10, 26 and 52 weeks, with the 10 items of the Oswestry Disability Index modelled as continuous variables and treatment group (Individualised Physiotherapy or Advice) modelled as a dichotomous variable. A Mixed Graphical Model was used to estimate associations between variables in the network, while centrality indices (Strength, Closeness and Betweenness) were calculated to determine the importance of each variable.

RESULTS

Individualised Physiotherapy was directly related to lower Sleep and Pain scores at all follow-up time points relative to advice, as well as a lower Standing score at 10-weeks, and higher Lifting and Travelling scores at 5-weeks. The strongest associations in the network were between Sitting and Travelling at weeks 5 and 26, between Walking and Standing at week 10, and between Sitting and Standing scores at week 52. ODI items with the highest centrality measures were consistently found to be Pain, Work and Social Life.

CONCLUSION

This study represents the first to understand how individualised physiotherapy or advice differentially altered disability in people with LBP. Individualised Physiotherapy directly reduced Pain and Sleep more effectively than advice, which in turn may have facilitated improvements in other disability items. Through their high centrality measures, Pain may be considered as a candidate therapeutic target for optimising LBP management, while Work and Socialising may need to be addressed via intermediary improvements in lifting, standing, walking, travelling or sleep. Slower (5-week follow-up) improvements in Lifting and Travelling as an intended element of the Individualised Physiotherapy approach did not negatively impact any longer-term outcomes.

TRIALS REGISTRATION

ACTRN12609000834257.

Understanding the Psychophysiological Mechanisms Related to Widespread Pressure Pain Hyperalgesia Underpinning Carpal Tunnel Syndrome: A Network Analysis Approach

OBJECTIVE

Current evidence suggests that carpal tunnel syndrome (CTS) involves widespread pressure pain sensitivity as manifestion of central sensitization. This study aimed to quantify mechanisms driving widespread pressure pain hyperalgesia in CTS by using network analysis.

DESIGN

Cross-sectional.

SETTING

Urban hospital.

SUBJECTS

120 women with CTS who participated in a previous randomized clinical trial.

METHODS

Pain intensity, related-function, symptom's severity, depressive levels, and pressure pain threshold (PPTs) over median, radial and ulnar nerves, the cervical spine, the carpal tunnel, and the tibialis anterior were collected. Network analysis was used to quantify the adjusted correlations between the modelled variables, and to determine the centrality indices of each variable (i.e., the degree of connection with other symptoms in the network).

RESULTS

The estimated network showed several local associations between clinical variables and the psychophysical outcomes separately. The edges with the strongest weights were between PPT over the median and radial nerves (ρ: 0.34), function and depressive levels (ρ: 0.30), and PPT over the carpal tunnel and tibialis anterior (ρ: 0.29). The most central variables were PPT over the tibialis anterior (the highest Strength centrality), and PPT over the carpal tunnel (the highest Closeness and Betweenness centrality).

CONCLUSIONS

This is the first study to apply network analysis to understand the multivariate mechanisms of individuals with CTS. Our findings support a model where clinical, depression, and widespread pressure pain sensitivity are connected, albeit within separate clusters. Clinical implications of current findings, such as developing treatments targeting these mechanisms, are also discussed.