Child eating behavior predicts body mass index after 1 year: results from the Swiss Preschooler's Health Study (SPLASHY)

Child obesity is a growing global issue. Preventing early development of overweight and obesity requires identifying reliable risk factors for high body mass index (BMI) in children. Child eating behavior might be an important and malleable risk factor that can be reliably assessed with the parent-report Child Eating Behavior Questionnaire (CEBQ). Using a hierarchical dataset (children nested within child care centers) from a representative cohort of Swiss preschool children, we tested whether eating behavior, assessed with a 7-factor solution of the CEBQ, and BMI at baseline predicted the outcome BMI after 1 year, controlling for socioeconomic status (n = 555; 47% female; mean age = 3.9 years, range: 2.2-6.6; mean BMI = 16 kg/m2, range: 11.2-23; mean age- and sex-corrected z-transformed BMI, zBMI = 0.4, range -4 to +4.7). The statistical model explained 65.2% of zBMI at follow-up. Baseline zBMI was a strong positive predictor, uniquely explaining 48.8% of outcome variance. A linear combination of all CEBQ scales, taken together, explained 10.7% of outcome variance. Due to their intercorrelations, uniquely explained variance by any individual scale was of negligible clinical relevance. Only food responsiveness was a significant predictor, when accounting for all other predictors and covariates in the model, and uniquely explained only 0.4% of outcome variance. Altogether, our results confirm, extend, and refine previous research on eating behavior and zBMI in preschool children, by adjusting for covariates, accounting for intercorrelations between predictors, partitioning explained outcome variance, and providing standardized beta estimates. Our findings show the importance of carefully examining the contribution of predictors in multiple regression models for clinically relevant outcomes.

How mood is affected by environment and upsetting events: The moderating role of psychological flexibility

OBJECTIVE

Patients suffering from psychological disorders report decreased quality of life and low mood. The relationship of these symptoms to daily upsetting events or environments, and in the context of active coping mechanisms is poorly understood. The present study thus investigates the association between mood, psychological flexibility, upsetting events, and environment in the daily life of outpatients.

METHOD

We investigated 80 outpatients at the beginning of treatment, using event sampling methodology (ESM). Patients' mood, occurrence of upsetting events, current environment, and psychological flexibility were sampled six times per day during a one-week intensive longitudinal examination. Data were analyzed using linear mixed models (LMMs).

RESULTS

Participants reported worse mood the more upsetting events they experienced. Further, participants reported better mood when in private environments (e.g., with friends), and worse mood when at the hospital, compared to being at home. Higher levels of psychological flexibility, however, were associated with better mood, irrespective of the occurrence of upsetting events or current environment.

CONCLUSION

Results suggest that mood is positively associated with psychological flexibility, not despite, but especially during the dynamic and context-specific challenges of daily life. Psychological flexibility may thus potentially act as a buffer against distress-provoking situations as patients go about their daily lives.

TRIAL REGISTRATION

ISRCTN.org identifier: ISRCTN11209732.

Just Not Enough: Utilization of Outpatient Psychotherapy Provided by Clinical Psychologists for Patients With Psychosis and Bipolar Disorder in Switzerland

Treatment guidelines state that evidence-based psychotherapy is effective for people with psychosis and bipolar disorder and should be offered during every phase of the treatment process. However, research has indicated a lack of outpatient psychotherapeutic services for this patient group, for example, in the United States or Germany. We extend this finding by presenting survey data from Switzerland. We surveyed 112 inpatients with a diagnosis of a schizophrenia spectrum disorder or bipolar disorder and assessed outpatient treatment over the 5 years prior to their index hospitalization by using retrospective self-reports. The survey focused on psychotherapy provided by clinical psychologists. Results indicate that only 23.2% of participants retrospectively reported having utilized any outpatient psychotherapy within the reporting period and only 8% of participants reported having received a number of outpatient sessions that reaches recommended levels of psychotherapy. Exploratory analyses did not detect a significant association between self-reported utilization of outpatient psychotherapy sessions and most demographic, psychiatric, and psychological attributes, but patients with a bipolar disorder diagnosis (vs schizophrenia spectrum diagnosis) reported having utilized outpatient treatment more often. These findings are preliminary. When replicated they highlight the need for increased access to outpatient psychotherapy and better alignment between guideline recommendations and outpatient supply.

Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period

Introduction

It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity.

Methods

We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later.

Results

Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period.

Discussion/Conclusion

Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.

Eating behaviour in Swiss preschool children-Validation of a German and a French version of the Children's Eating Behaviour Questionnaire (CEBQ)

Young children's eating behavior is crucial for any further development of healthy eating. Early eating behavior are often assessed through parental report. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used parental questionnaire that has been validated in families of different gender, age and cultural background. Research has shown that the 8-factor structure has some inconsistencies and sample characteristics such as age, gender, and culture can influence the results. To which extent such sample characteristics might influence results within a multi-lingual culture has not been investigated so far. Therefore, the aim of the study was to evaluate the factor structure of the CEBQ among 511 preschool children of the French and German parts of Switzerland, aged 2 to 6 years (Mean 3.85 years; SD 0.69). Confirmatory Factor Analysis showed a modified structure of the original questionnaire, with a 7-factor structure providing a reasonable fit to the data (TLI = 0.954, CFI = 0.952, RMSEA = 0.063 and SRMR = 0.067). The subscale 'Desire to drink' was removed, and a few items moved to other subscales as they loaded higher on a different subscale compared to the original model. Reliabilities based on the coefficient omega were acceptable to satisfying across the seven factors, ranging from 0.66 to 0.90. There were no significant gender or age differences, but French speaking children showed higher levels of 'Satiety responsiveness' and lower 'Enjoyment of food' than German speaking children. Yet, these effects were small. The German and French CEBQ are valid and reliable versions of the original CEBQ and can be used in a multicultural context.

Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating

BACKGROUND

Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT).

METHODS

Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design).

RESULTS

The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up.

CONCLUSIONS

This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level.

TRIAL REGISTRATION

The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).

Stress, mental health and sociocultural adjustment in third culture kids: exploring the mediating roles of resilience and family functioning

Introduction

This cross-sectional study explores the contributions of personal and contextual factors in the adjustment process of a sample of internationally mobile children and adolescents having relocated to Switzerland. Based on evolutionary developmental theories and recommendations by Research Domain Criteria and The Hierarchical Taxonomy of Psychopathology theoretical frameworks, we hypothesized and tested a heuristic model of TCK adjustment, aiming to identify prevention and treatment targets tailored for our sampled population.

Methods

We assessed the relationships in the hypothesized models, particularly how perceived and acculturative stress influence TCK adjustment and whether the relationship between the predictors of TCK stress and the outcomes of TCK adjustment are mediated by resilience and family functioning. A total of 143 participants aged 7-17, having relocated internationally with their working parent(s), recruited in local and international schools in Switzerland, were included in this study. Data were collected using an online survey after we collected consent. We assessed factors of adjustment using validated questionnaires: perceived stress and acculturative stress and the potential mediating roles of family functioning and resilience. We measured the outcome of adjustment through mental health difficulties and sociocultural adjustment. We used path analysis to test the model.

Results

Results highlight the contributions of perceived stress and acculturative stress to TCK mental health and sociocultural adjustment. We also we found a mediation effect for resilience in the relationship between perceived stress and mental health. Family functioning was not a significant mediator in any relationship that we assessed.

Discussion

We discuss implications for future research, promoting TCK adjustment and preventative psychotherapeutic interventions.

Therapeutic leave and direct inpatient healthcare costs in inpatients with mental illness

AIMS

Balancing the economic costs related to mental illness is a pressing matter globally. Scarce monetary and staff resources impose an ongoing challenge. Therapeutic leaves (TL) are an established clinical tool in psychiatry possibly improving therapy outcome and potentially lowering direct mental healthcare costs in the long term. We thus examined the association between TL and direct inpatient healthcare costs.

METHODS

We analyzed the association between the number of TL and direct inpatient healthcare costs in a sample of 3151 inpatients, using a tweedie multiple regression model, including eleven confounders. Using multiple linear (bootstrap) and logistic regression models we assessed the robustness of our results.

RESULTS

The tweedie model showed that the number of TL was associated with lower costs following the initial inpatient stay (B = -.141, CI 95% = [-0.225, -.057], p < 0.001). Results of the multiple linear and the logistic regression models matched those of the tweedie model.

CONCLUSION

Our findings suggest a link between TL and direct inpatient healthcare costs. TL might lower direct inpatient healthcare costs. In the future RCTs might examine whether an increased utilization of TL leads to a reduction of outpatient treatment costs and evaluate the association of TL with outpatient treatment costs and indirect costs. The systematic use of TL during inpatient treatment could reduce healthcare costs following the initial inpatient stay which is highly relevant due to global rise of mental illness and the associated financial pressure on healthcare systems.

Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The "Choose Change" Effectiveness Trial

INTRODUCTION

Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions.

OBJECTIVE

The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient).

METHODS

The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]).

RESULTS

Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes.

CONCLUSIONS

Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings.

TRIAL REGISTRATION

This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.

The relationship of parenting style and eating behavior in preschool children

BACKGROUND

Eating behavior represents individual appetitive traits which are related to the individual's regulation of food intake. Eating behavior develops at an early age. There is some evidence that parenting styles might impact on the child's eating behavior. The aim of this study was to investigate the relationship of different dimensions of positive and negative parenting styles with the child's eating behavior at a critical age period of the child's early development.

METHODS

Parents of 511 preschool children (aged 2-6 years) completed the Children Eating Behavior Questionnaire and the Alabama Parenting Questionnaire.

RESULTS

Analyses revealed that different dimensions of negative parenting styles were associated with eating behavior of the child. In details, inconsistent parenting showed a consistent association with eating behavior of a child (i.e. higher emotional eating, higher food responsiveness, higher food fussiness, higher satiety responsiveness and more enjoyment of food), whereas corporal punishment was associated with more emotional overeating and more food responsiveness but less satiety responsiveness. Further, powerful implementation was related to higher food responsiveness and less enjoyment of food and low monitoring was associated with higher emotional overeating and more slowness in eating. There was no such consistent association of positive parenting and eating behavior.

CONCLUSIONS

More negative parenting styles were associated with eating behavior which is more often related to potential weight problems in a long term, whereas positive parenting did not show such a consistent relationship with eating behavior. Negative parenting should be in the focus of prevention and treatment of eating behavior problems in young children.

TRIAL REGISTRATION

ISRCTN41045021 (06/05/2014).

Is helping you helping me? The assessment of helping others using event sampling methodology in a clinical and a non‐clinical sample

Individuals diagnosed with major depressive disorder (MDD) and social phobia (SP) have difficulties in social interactions. It is unknown, however, whether such difficulties prevent them from helping others, thereby depriving them of the natural benefits of helping, such as receiving gratitude. Using event sampling methodology (ESM), individuals (MDD, n = 118; SP, n = 47; and control group, n = 119) responded to questions about the frequency of helping, in total at 5333 time points, and their well-being. Contrary to our hypothesis, individuals in the MDD, SP and control group did not differ in their helping frequency. Results did show an association between helping and well-being, such that helping is related to well-being and well-being to helping. Understanding the complex relation of helping others and well-being and how this might be used during therapy and prevention programmes are discussed.

Is intuition allied with jumping to conclusions in decision-making? An intensive longitudinal study in patients with delusions and in non-clinical individuals

Research suggests that a jumping-to-conclusions (JTC) bias, excessive intuition, and reduced analysis in information processing may favor suboptimal decision-making, both in non-clinical and mentally disordered individuals. The temporal relationship between processing modes and JTC bias, however, remains unexplored. Therefore, using an experience sampling methodology (ESM) approach, this study examines the temporal associations between intuitive/analytical information processing, JTC bias, and delusions in non-clinical individuals and patients with schizophrenia. Specifically, we examine whether a high use of intuitive and/or a low use of analytical processing predicts subsequent JTC bias and paranoid conviction. In a smartphone-based ESM study, participants will be prompted four times per day over three consecutive days to answer questionnaires designed to measure JTC bias, paranoid conviction, and preceding everyday-life intuition/analysis. Our hierarchical data will be analyzed using multilevel modelling for hypothesis testing. Results will further elucidate the role of aberrant human reasoning, particularly intuition, in (non-)clinical delusions and delusion-like experiences, and also inform general information processing models.

Consequences of exposure to the thin ideal in mass media depend on moderators in young women: An experimental study

This study examined the consequences of media exposure to thin ideals compared to pictures of landscapes in healthy young women and women with eating and mixed mental disorders and investigated whether appearance-related cognitive factors and cognitive distortions moderate the effects. Two hundred seventy-five women in a multisite laboratory trial (174 in- or outpatients and 101 healthy women; M_age 22.87 years, SD = 3.94) were exposed to either thin ideals or to landscape pictures and guided through a vivid imagery of these pictures thereafter. Changes in body image dissatisfaction, mood, eating behavior, and physiological markers were assessed. After thin ideal exposure and even more after guided imagery, women's body image dissatisfaction increased and mood declined. The effect on mood was most pronounced in women with eating disorders, less in women with mixed disorders, and smallest in healthy controls. No effects were found on physiological measures. Higher values of appearance-related cognitive factors moderated the effect of thin ideal exposure and guided imagery on all psychological outcomes. Cognitive distortions moderated the effect of thin ideal exposure and guided imagery on mood. Findings indicate an overall susceptibility to viewing thin ideal pictures in magazines in young and especially in women with eating disorders. Though exposure in the laboratory resulted in psychological effects, it did not lead to a physiological stress response. The impact of thin ideal exposure on mood is in line with affect-regulation models in eating disorders, with appearance-related cognitive factors and cognitive distortions potentially accelerating such effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Walking onset: a poor predictor for motor and cognitive skills in healthy preschool children

Background

The onset of walking is thought to be an indicator of early development. However, evidence is mixed and clear data on this relationship at preschool age is missing. The study aimed at investigating if walking onset and motor and cognitive development in preschool children are related.

Methods

A total of 555 children (mean age 3.86 years) of the Swiss Preschoolers’ Health Study SPLASHY were tested twice at their childcare center (at baseline and one year later). Motor skills and cognitive skills were assessed by standardized testing procedures and parents were asked to provide information on walking onset of their child.

Results

Late onset of walking was related to poorer motor skills (fine motor skills, static and dynamic balance (all p < 0.003)) and poorer cognitive skills (selective attention and visual perception (p = 0.02; p = 0.001) in late preschool age.

Conclusions

For children with late walking onset a close monitoring of their development in the regular pediatric child health visits may be reasonable.

Trial registration: ISRCTN41045021.

BED-online: Acceptance and efficacy of an internet-based treatment for binge-eating disorder: A randomized clinical trial including waitlist conditions

Objective

Internet‐based guided self‐help (GSH) programs increase accessibility and utilization of evidence‐based treatments in binge‐eating disorder (BED). We evaluated acceptance and short as well as long‐term efficacy of our 8‐session internet‐based GSH program in a randomized clinical trial with an immediate treatment group, and two waitlist control groups, which differed with respect to whether patients received positive expectation induction during waiting or not.

Method

Sixty‐three patients (87% female, mean age 37.2 years) followed the eight‐session guided cognitive‐behavioural internet‐based program and three booster sessions in a randomized clinical trial design including an immediate treatment and two waitlist control conditions. Outcomes were treatment acceptance, number of weekly binge‐eating episodes, eating disorder pathology, depressiveness, and level of psychosocial functioning.

Results

Treatment satisfaction was high, even though 27% of all patients dropped out during the active treatment and 9.5% during the follow‐up period of 6 months. The treatment, in contrast to the waiting conditions, led to a significant reduction of weekly binge‐eating episodes from 3.4 to 1.7 with no apparent rebound effect during follow‐up. All other outcomes improved as well during active treatment. Email‐based positive expectation induction during waiting period prior to the treatment did not have an additional beneficial effect on the temporal course and thus treatment success, of binge episodes in this study.

Conclusion

This short internet‐based program was clearly accepted and highly effective regarding core features of BED. Dropout rates were higher in the active and lower in the follow‐up period. Positive expectations did not have an impact on treatment effects.

The present internet‐based guided self‐help program adds to the existing research regarding online treatment of binge‐eating disorder and is currently one of the two existing validated programs available in German language. It is based on an established cognitive‐behavioural treatment approach, shows high acceptance by patients and high efficacy after eight guided online sessions, thereby representing the shortest duration of currently evaluated treatments

During the internet‐based therapy, the number of weekly binge‐eating episodes, depressive symptoms, eating disorder pathology as well as impairments in psychosocial functioning all significantly decreased. These positive effects were maintained during follow‐up (6 months). Abstainer rate (no binge‐eating during last month) continued to increase during follow‐up with booster sessions

An email‐based pre‐treatment positive expectation induction did not alter the temporal course and thus treatment success, of binge episodes

Having versus not having social interactions in patients diagnosed with depression or social phobia and controls

Humans need meaningful social interactions, but little is known about the consequences of not having them. We examined meaningful social interactions and the lack thereof in patients diagnosed with major depressive disorder (MDD) or social phobia (SP) and compared them to a control group (CG). Using event-sampling methodology, we sampled participants’ everyday social behavior 6 times per day for 1 week in participants’ natural environment. We investigated the quality and the proportion of meaningful social interactions (when they had meaningful social interactions) and degree of wishing for and avoidance of meaningful social interactions (when they did not have meaningful social interactions). Groups differed on the quality and avoidance of meaningful social interactions: Participants with MDD and SP reported perceiving their meaningful social interactions as lower quality (in terms of subjective meaningfulness) than the CG, with SP patients reporting even lower quality than the MDD patients. Further, both MDD and SP patients reported avoiding meaningful social interactions significantly more often than the CG. Although the proportion of meaningful social interactions was similar in all groups, the subjective quality of meaningful social interactions was perceived to be lower in MDD and SP patients. Future research might further identify what variables influenced the reinforcement of the MDD and SP patients so that they engaged in the same number of meaningful social interactions even though the quality of their meaningful social interactions was lower. Increasing awareness of what happens when patients do or do not have meaningful social interactions will help elucidate a potentially exacerbating or maintaining factor of the disorders.

The spatiotemporal movement of patients in and out of a psychiatric hospital: an observational GPS study

BACKGROUND

Movement is a basic component of health. Little is known about the spatiotemporal movement of patients with mental disorders. The aim of this study was to determine how spatiotemporal movement of patients related to their symptoms and wellbeing.

METHOD

A total of 106 patients (inpatients (n = 69) and outpatients (n = 37)) treated for a wide range of mental disorders (transdiagnostic sample) carried a GPS-enabled smartphone for one week at the beginning of treatment. Algorithms were applied to establish spatiotemporal clusters and subsequently related to known characteristics of these groups (i.e., at the hospital, at home). Symptomatology, Wellbeing, and Psychological flexibility were also assessed.

RESULTS

Spatiotemporal patterns of inpatients and outpatients showed differences consistent with predictions (e.g., outpatients showed higher active areas). These patterns were largely unassociated with symptoms (except for agoraphobic symptoms). Greater movement and variety of movement were more predictive of wellbeing, however, in both inpatients and outpatients.

CONCLUSION

Measuring spatiotemporal patterns is feasible, predictive of wellbeing, and may be a marker of patient functioning. Ethical issues of collecting GPS data are discussed.

Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder

Evidence suggests that narcissism and borderline personality disorder are associated with each other. This naturalistic study investigated the predictive value of grandiose and vulnerable narcissism on the development of the therapeutic alliance in short-term psychodynamic treatment across 12 weeks. The sample consisted of 99 patients with borderline personality disorder. Narcissism was assessed with the Pathological Narcissism Inventory at treatment onset. The therapeutic alliance was rated with the Scale to Assess Therapeutic Relationships by both patient and therapist at four time points during treatment. Results showed a significant predictive value of vulnerable narcissism on the therapeutic alliance, revealing a more beneficial progression for patients with higher vulnerable narcissism. Grandiose narcissism had no predictive value on the therapeutic alliance. The study strengthens the clinical utility of the concept of vulnerable narcissism towards the evaluation of treatment processes in borderline personality disorder.

Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme

Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8 weeks and second follow-up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.

Increasing prosocial behavior and decreasing selfishness in the lab and everyday life

The tension between selfishness and prosocial behavior is crucial to understanding many social interactions and conflicts. Currently little is known how to promote prosocial behaviors, especially in naturally occurring relationships outside the laboratory. We examined whether a psychological micro-intervention would promote prosocial behaviors in couples. Across two studies, we randomized dyads of couples to a micro-intervention (15 min), which increased prosocial behaviors by 28% and decreased selfish behaviors by 35% a week later in behavioral games in a dose-response manner. Using event sampling methodology, we further observed an increase in prosocial behaviors across one week that was most pronounced in participants who received the intervention. These results from the laboratory and everyday life are important for researchers interested in prosocial behavior and selfishness and have practical relevance for group interactions.

Cardiac vagal tone in preschool children: Interrelations and the role of stress exposure

INTRODUCTION

Cardiac vagal tone has been understood as the biological correlate of emotion regulation and can be divided into emotion regulation (tonic cardiac vagal tone (TCVT)) and the flexibility to adapt to changing conditions (phasic cardiac vagal tone (PCVT)). There is evidence that TCVT influences PCVT dynamics in adults and that stress exposure impacts on cardiac vagal tone in adults and older children. The aim of the study was to investigate the impact of TCVT on PCVT dynamics in preschoolers and to identify the influence of stress exposures on cardiac vagal tone.

METHOD

Measures of heart rate variability including baseline (TCVT), during an age-adapted stress task (PCVT stress reactivity) and during recovery (PCVT recovery) were assessed in 222 children aged 2-6 years of the SPLASHY study. Further, parents were asked to complete questionnaires on early stress exposure (including pregnancy, birth and early life) and current stress exposure (including family stress and parenting).

RESULTS

Preschool children with high TCVT showed less PCVT reactivity (p < 0.001) and more increase of vagal tone (PCVT) during early recovery (p = 0.016). Further only child's low birth weight was a relevant stress exposure impacting on early and late PCVT recovery (p = 0.03/p = 0.005). None of the other early or late stress exposure conditions, nor the accumulation of stress exposures influenced TCVT or PCVT dynamics in these healthy preschoolers.

DISCUSSION

TCVT impacts on PCVT dynamics in a lab-based stress task in healthy preschool children and only low birth weight is related to more change during early and to less late PCVT recovery.

The everyday lives of in- and outpatients when beginning therapy: The importance of values-consistent behavior

Background/Objective

The manifestation of functional impairment in patients’ daily lives and interference with things they value is poorly understood. If values are compromised in patients, as theory suggests, social contexts (and the lack thereof) are especially important – though this is currently unexplored. We therefore examined whether daily values-consistent behavior was associated with the importance of a value and whether it involved social or non-social activity.

Method

Using Event Sampling Methodology, we examined daily values-consistent behavior in 57 transdiagnostic inpatients and 43 transdiagnostic outpatients at the beginning of treatment. Patients’ values-consistent behavior, its importance, and (social vs non-social) context was sampled six times per day during a one-week intensive longitudinal examination.

Results

Across both groups, the probability of subsequent values-consistent behavior increased if (1) it was judged as more important by the patient or (2) if it was embedded in a social context. The probability of reporting values-consistent behavior was higher for outpatients than inpatients.

Conclusions

Clinicians are encouraged to examine the values of their patients more closely and to especially monitor important and/or social values. Incorporating these into clinical work might increase patients’ values-consistent behavior, which can play a role in reducing suffering.

Motor Competence and Physical Activity in Early Childhood: Stability and Relationship

Background: Normal motor development and adequate levels of physical activity engagement during the early years of life form the foundation of long-term psychological and physiological health. This is one of the very few studies that investigate the stability and relationships of motor competence and physical activity in preschool children.

Methods: Baseline and 12 month follow-up data of physical activity and motor competence of 550 preschool children aged 2–6 years from the Swiss Preschoolers' Health Study were used for this work. Physical activity data, expressed in counts per minute for total physical activity and minutes per day for time spent moderately-to-vigorously physically active, were collected over 1 week using accelerometers. Motor competence was assessed with the Zurich Neuromotor Assessment. Both motor competence and physical activity were age- and sex-adjusted. To examine the individual stability of physical activity and motor competence and reciprocal cross-sectional and longitudinal effects between these two domains, a latent variable cross-lagged panel model where motor competence was represented through a latent construct was examined using structural equation modeling.

Results: A weak cross-sectional correlation of motor competence with total physical activity (r = 0.24) and moderate-to-vigorous physical activity (r = 0.23) was found. Motor competence exhibited high stability (β = 0.82) in the preschool years and physical activity was moderately stable with estimates ranging from β = 0.37 for total physical activity to β = 0.48 for moderate-to-vigorous physical activity. In contrast to the autoregressive coefficients denoting individual stability, both cross-lagged effects were negligible indicating that physical activity was not a determinant of motor competence or vice versa.

Conclusions: Motor competence and physical activity developed independently of each other in early childhood. Although measures of quantity and intensity of physical activity were not related to motor development, specific movement experiences and practice—which are not reflected by accelerometry—may be needed for skill development. Future research should focus on examining what type of physical activity is important for motor development and how to assess it, and also whether the relationship between physical activity and motor competence evolves over time.

Clinical Trial Registration: Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14)

The effect of anticipatory stress and openness and engagement on subsequently perceived sleep quality-An Experience Sampling Method study

High stress levels can influence sleep quality negatively. If this also applies to anticipatory stress is poorly documented, however. Across insomnia severity levels, this study examined participants' evening levels of (a) anticipatory stress and (b) their skills hypothesized to downregulate the impact of stress, namely openness to internal experiences and continuous engagement in meaningful activities (openness and engagement) and their association with the quality of the subsequent night's sleep. The moderating role of insomnia severity was also tested. We used a quasi-experimental longitudinal design with Experience Sampling Method using smartphones over the course of 1 week (3,976 assessments; 93.2% of prompted queries). Participants recorded their sleep quality, anticipatory stress, and openness and engagement within their daily context. Participants included in the study were diagnosed with major depressive disorder (n = 118), social phobia (n = 47) or belonged to the control group (n = 119). Both anticipatory stress and openness and engagement predicted subsequent sleep quality. Diagnostic group was associated with overall sleep quality, but did not interact with the predictors. These findings were invariant across levels of self-reported insomnia severity. Furthermore, openness and engagement and anticipatory stress did not interact in their effect on sleep quality. The results suggest that both stress reduction and increased openness and engagement are associated with improved subjective sleep quality on a day to day basis, regardless of insomnia severity. Targeting these variables may help improve sleep quality. Future research should disentangle the effects of openness and engagement on anticipatory stress.

Association of physical activity with adiposity in preschoolers using different clinical adiposity measures: a cross-sectional study

Background

More research is needed about the association between physical activity (PA), sedentary behaviour (SB), and adiposity in preschoolers, particularly using more direct clinical measures of adiposity. Therefore, the main objective of this study was to investigate the association between objectively measured PA and different clinical adiposity measures in a large sample of preschoolers.

Methods

Four hundred sixty-three predominantly normal-weight (77%) 2–6-year-old preschool children participated in the Swiss Preschoolers’ Health Study (SPLASHY). Physical activity was measured using accelerometers and was analyzed using 15-s (uni-axial) epoch length using validated cut-offs. Adiposity measures included body mass index (BMI), the sum of four skinfolds, and waist circumference (WC). Multilevel linear regression modeling, adjusted for age, sex and wear time, was used to assess the association between PA and SB with BMI, WC, and skinfold thickness.

Results

Total PA and different PA intensities were positively and SB was inversely associated with BMI in the total sample and in the normal-weight children (p < 0.05). Total PA was inversely associated with skinfold thickness in overweight and obese children (p < 0.05), while there was only a weak association for vigorous PA (p > 0.05). Moderate and moderate-to-vigorous PA were positively, and SB was negatively associated with WC in the total sample and in the normal-weight children (p < 0.05). Additional adjustment for potential sociocultural and biological confounding variables attenuated some of the results.

Conclusions

In this very young and predominantly normal-weight population, PA is positively related to BMI and WC, but this relationship is not observed in overweight and obese children. In this latter population, PA is inversely, and SB is positively related to skinfold thickness. Skinfold thickness could represent a useful and simple clinical measure of body fat in preschoolers. The role of vigorous PA in the prevention of early childhood obesity should be further investigated in future studies.

Trial registration

ISRCTN ISRCTN41045021. Retrospectively registered 06 May 2014.

Increased sensitivity to social exclusion during the luteal phase: Progesterone as resilience factor buffering against ostracism?

A woman's social behaviour reportedly varies across the menstrual cycle. In this study, we estimated changes in sensitivity to social exclusion across the menstrual cycle and scrutinized the related role of progesterone. Forty-nine naturally cycling women played a virtual ball-tossing game (Cyberball) to manipulate social inclusion. All participants underwent inclusion and exclusion conditions during the late follicular and the luteal phase. We assessed salivary progesterone concentrations at each cycle phase. After each Cyberball session we measured positive/negative mood using the Multidimensional Mood State Questionnaire (MDMQ). Multilevel analyses indicated that women showed worse mood following exclusion as compared to inclusion conditions (p = 0.014). Notably, this exclusion effect was more pronounced during the luteal phase than the late follicular phase (p = 0.029). As expected, progesterone concentrations were higher during the luteal phase as compared to the late follicular phase, but interestingly, progesterone concentrations were negatively associated with exclusion effects. When accounting for mediation via progesterone, direct cycle-phase related differences in social exclusion effects even increased as compared to the model without mediator. These findings suggest that progesterone may function as buffer against negative feelings that result from being socially excluded. The relevance of these findings for Premenstrual Dysphoric Disorder (PMDD) are discussed, and we conclude that social exclusion may represent an important research domain criterion (RDoC) of relevance for PMDD, with progesterone pointing to new potential pharmacological targets.

Polypharmacy and drug-drug interactions among older and younger male prisoners in Switzerland

PURPOSE

The purpose of this paper is to determine the prevalence of polypharmacy and drug-drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs.

DESIGN/METHODOLOGY/APPROACH

For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models.

FINDINGS

On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (p = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52, p = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94; p = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant.

ORIGINALITY/VALUE

Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies.

General or specific? The memory-experience gap for individuals diagnosed with a major depressive disorder or a social phobia diagnosis, and individuals without such diagnoses

Psychological treatment and assessment necessarily rely on patients' recall. Yet several empirical studies have documented a gap between memory and real-life experience (i.e., memory-experience gap; MeG). We investigated and compared the MeG of sadness, social anxiety, happiness, and physical activity for participants diagnosed with a major depressive disorder (MDD), a social phobia (SP), and participants without such diagnoses (CG). The study included 118 participants diagnosed with a MDD, 47 with a SP, and 119 CG. Using event-sampling methods (ESM), participants were asked via smartphone to report their experiences throughout a week and then to recall those again retrospectively at the end of the study week. Results indicate significant differences in the MeG with respect to the experience that was salient to them (e.g., MDD group - sadness; SP group - social anxiety; CG group - happiness). Furthermore, all groups showed a MeG for physical activity and, the results indicate significant group differences in the magnitude of the MeGs. This study demonstrated the presence of a MeG in individuals in a MDD, SP, and CG group and in positive and negative affective experiences. Differential patterns across the samples contribute to a better understanding of this gap and its implications.

"Choose change": design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients

BACKGROUND

Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome.

METHODS

This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context.

DISCUSSION

We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting.

TRIAL REGISTRATION

This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.

Prevalence and Predictors of Behavioral Problems in Healthy Swiss Preschool Children Over a One Year Period

Behavioral problems impair children's health but prevalence rates are scarce and persistence rates vary due to divergence in age ranges, assessment methods and varying environmental factors. The aim of this study was to assess prevalence rates of behavioral problems, their persistence over a 1-year period, and the impact of child- and parent-related factors on behavioral problems. 555 2-6-year-old healthy preschool children were assessed at baseline and 382 of the initial sample at 1-year follow-up. Assessment included questionnaires concerning behavioral problems and their potential predictors (e.g. socio-economic status or parenting style). Altogether, nearly 7% of these children showed clinically relevant behavioral problems, and 3% showed persistent symptoms. Low SES, inconsistent parenting and corporal punishment were positively associated with behavioral problems. The prevalence rates of behavioral problems in Swiss preschoolers are similar to other European countries, but persistence is still rather low within preschool age. These findings need further confirmation in longitudinal studies.

Accelerometer-derived physical activity estimation in preschoolers - comparison of cut-point sets incorporating the vector magnitude vs the vertical axis

Background

ActiGraph accelerometers are a widely used tool to objectively measure physical activity (PA) behavior in young children and several validated cut-point sets exist to estimate time spent in different PA intensities (sedentary time, light PA, moderate-to-vigorous PA). Applying different cut-point sets leads to large and meaningful differences in results. So far, only cut-point sets validated for the vertical axis have been compared and only the influence on time spent in moderate-to-vigorous PA has been analyzed.

Methods

A range of validated cut-point sets with their respective epoch length was applied to analyze cross-sectional data of the Swiss Preschoolers’ Health Study (SPLASHY): 1) Vertical axis in combination with an epoch length of 15 s (VA-15), 2) Vertical axis in combination with an epoch length of 60 s (VA-60) and 3) Vector magnitude in combination with an epoch length of 60 s (VM-60). PA was measured for eight consecutive days using ActiGraph accelerometers (wGT3X-BT). Three days were required to be included in the analysis (minimum two weekdays and one weekend-day with at least ten hours recording per day).

Results

Four hundred forty-five preschoolers (mean age 3.9 ± 0.5 years; 46% girls) had valid accelerometer measurements. A longer epoch (VA-60 vs VA-15) resulted in 2% less sedentary time (ST), 18% more light PA (LPA) and 51% less moderate-to-vigorous PA (MVPA); using the vector magnitude compared to the vertical axis (VM-60 vs VA-60) resulted in 34% less ST, 27% more LPA and 63% more MVPA (all p ≤ 0.001). Comparing all three sets of cut-points, ST ranged from 4.0 to 6.2 h, LPA from 5.1 to 7.6 h and MVPA from 0.8 to 1.6 h.

Conclusions

Estimated time spent in different PA intensities was strongly influenced by the choice of cut-point sets. Both, axis selection and epoch length need to be considered when comparing different studies especially when they relate PA behavior to health. The differences in the prevalence of children fulfilling PA guidelines highlight the relevance of these findings.

Trial registration

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.2014).

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6837-7) contains supplementary material, which is available to authorized users.

Alternative Model of Personality Disorders (DSM-5) Predicts Dropout in Inpatient Psychotherapy for Patients With Personality Disorder

Objective

Criterion A serves as the fundamental diagnostic criterion of the Alternative Model of Personality Disorders in section III of the Diagnostic and Statistical Manual 5. Consisting of a self- and an interpersonal dimension, it defines the construct of personality functioning as a general and dimensional factor of personality disorders. This study aimed to explore criterion A along with well-established treatment dropout predictors, e.g., sociodemographic factors, personality disorder diagnosis, symptom severity, and the therapeutic alliance.

Methods

The sample consisted of 132 patients diagnosed with personality disorder in a psychotherapeutic inpatient treatment. Cox proportional hazard regression models and a lasso model were applied.

Results

28% of the sample prematurely discontinued treatment. The risk for dropout was 2.3 times higher for patients with high impairments in self-functioning as assessed with criterion A. Moreover, a positive therapist-rated therapeutic alliance was associated with a lower dropout risk.

Conclusion

The study suggests criterion A is a useful clinical indicator by identifying patients with personality disorder with a higher risk for dropout. An individualized therapeutic approach for such patients might be required.

Childcare Correlates of Physical Activity, Sedentary Behavior, and Adiposity in Preschool Children: A Cross-Sectional Analysis of the SPLASHY Study

Background

The childcare (CC) environment can influence young children's physical activity (PA), sedentary behavior (SB), and adiposity. The aim of the study was to identify a broad range of CC correlates of PA, SB, and adiposity in a large sample of preschoolers.

Methods

476 preschool children (mean age 3.9 yrs; 47% girls) participated in the Swiss Preschoolers' Health Study (SPLASHY). PA and SB were measured by accelerometry. Outcome measures included total PA (TPA), moderate-to-vigorous PA (MVPA), SB, body mass index (BMI), and skinfold thickness (SF). PA measures consisted of both daily PA during CC attendance days and overall daily PA (CC and non-CC days).

Results

We identified the following CC correlates for higher TPA and/or higher MVPA or lower SB during CC attendance days: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, and the presence of a written PA policy in the CC (all p ≤ 0.02). The CC correlates for overall TPA and/or MVPA or lower overall SB including both CC and non-CC days were the following: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, less parental PA involvement in the CC, and having a larger surface area in CC (all p ≤ 0.046). Correlates for lower SF were sex (boys) and parental PA involvement in the CC (all p ≤ 0.02), and, for lower BMI, only increased age (p=0.001) was a correlate.

Conclusions

More frequent child-initiated interactions and mixing different ages in CC, the presence of a written PA policy, and a larger CC surface are correlates of PA and SB during CC attendance days and/or of overall PA. Parental involvement in CC PA projects was a correlate for reduced body fat. These novel factors are mostly modifiable and can be tackled/addressed in future interventions.

Predictors of Executive Functions in Preschoolers: Findings From the SPLASHY Study

Executive functions (EFs) have been reported to play a crucial role in children's development, affecting their academic achievement, health, and quality of life. This study examined individual and interpersonal predictors for EFs in 555 typically developing preschool children aged 2-6 years. Children were recruited from 84 child care centers in the German- and French-speaking parts of Switzerland within the Swiss Preschoolers' Health Study (SPLASHY). A total of 20 potential predictors were assessed at the first measurement (T1). These included eight demographic/biological predictors, such as socioeconomic status, preterm birth, physical activity, and motor skills; six psychological predictors, such as hyperactivity, visual perception, and emotionality; and six interpersonal predictors, such as parenting style and stress, presence of siblings, and days spent in the child care center. The predictive value of these variables on EFs 1 year later (T2) was assessed using both standard multiple regression analysis and penalized regression to avoid overfitting due to the number of potential predictors. Female sex (β = 0.14), socio-economic status (β = 0.15), fine motor skills (β = 0.17), visual perception at T1 (β = 0.16), and EFs at T1 (β = 0.30) were all associated with EFs at T2, exhibiting small to medium effect sizes. All predictors together accounted for 31% of the variability in EFs. However, none of the interpersonal predictors were significant. Thus, we conclude that most of the factors that can predict EFs in preschool age are individual variables, and these tend to be more difficult to influence than interpersonal factors. In fact, children from families with low socio-economic status may be particularly vulnerable to poor EFs. Furthermore, encouraging fine motor skills early in life may support the development of EFs.

Age-Adapted Stress Task in Preschoolers Does not Lead to Uniform Stress Responses

Acute stress response measures serve as an indicator of physiological functioning, but have previously led to contradictory results in young children due to age-related cortisol hypo-responsivity and methodological inconsistencies in assessment. The aim of this study was to investigate stress responses during a validated age-adapted socio-evaluative stress task in children aged 2-6 years in a child care environment and to detect socio-demographic, task- and child-related characteristics of stress responses. Stress responses were assessed in 323 children for salivary cortisol and salivary alpha amylase (sAA), and in 328 children for changes in heart rate variability (HRV). These data were then associated with socio-demographic (e.g. SES), task-related (e.g. task length) and child-related characteristics (e.g. self-regulation) of stress responses using multilevel models. Analyses revealed elevated sympathetic reactivity (sAA: Coeff=0.053, p=0.004) and reduced HRV (Coeff=-0.465, p<0.001), but no hypothalamic-pituitary-adrenal (HPA) response (Coeff=0.017, p=0.08) during the stress task. Child's age (Coeff=-5.82, p<0.001) and movement during the task (Coeff=-0.17, p=0.015) were associated with acute cortisol release, while diurnal sAA was associated with acute sAA release (Coeff=0.24, p<0.001). Age (Coeff=-0.15, p=0.006) and duration of the task (Coeff=0.13, p=0.015) were further associated with change of HRV under acute stress condition. Children showed inconsistent stress responses which contradicts the assumption of a parallel activation of both stress systems in a valid stress task for young children and might be explained by a pre-arousal to the task of young children in a child care setting. Further results confirm that child- and task-related conditions need to be considered when assessing stress responses in these young children.

Well-being in major depression and social phobia with and without comorbidity

Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.

Self-reported emotion regulation difficulties are associated with mood but not with the biological stress response to thin ideal exposure

BACKGROUND

Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD).

METHODS

Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18-35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0-100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS).

RESULTS

Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals.

DISCUSSION AND CONCLUSION

The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed.

Physical activity and sedentary behavior in preschoolers: a longitudinal assessment of trajectories and determinants

BACKGROUND

Despite physical activity (PA) being recognized as a critically important factor for good physical and mental health already early in life and throughout the life course, prospective data on activity behavior during the preschool years remains scarce. This study examined trajectories and determinants of levels and change in total PA (TPA), moderate-to-vigorous PA (MVPA) and sedentary behavior (SB) in a representative sample of Swiss preschoolers.

METHODS

Data were drawn from the Swiss Preschoolers' Health Study (SPLASHY), a multi-site prospective cohort study including 555 children (53% boys) aged 2-to-6 years at baseline. A follow-up was conducted after 12 months. Activity behavior was measured using accelerometers. Information on 35 potential determinants from different socio-ecological domains was either directly measured or parent-reported. Trajectories of TPA, MVPA and SB over time were described for boys and girls. Linear mixed models were used to investigate factors that predicted levels and change in TPA, MVPA and SB.

RESULTS

All children were sufficiently physically active according to published recommendations for preschoolers. Trajectory profiles revealed a marked increase in TPA and MVPA in boys and girls whereas SB remained fairly stable over time. Mixed modeling demonstrated that variables most relevant to determining PA levels were sex, age and activity temperament (all positively associated). Together with gross motor skills, birth weight, family structure (only for TPA) and season (only for MVPA), these factors accounted for 26 and 32% of total variance explained in TPA and MVPA, respectively. Activity temperament emerged as the strongest determinant of SB (negative association) and explained with sex, season and family structure 20% of total variance in SB. The presence of older siblings was the only factor that predicted change in PA over time.

CONCLUSIONS

In this healthy physically active cohort of preschoolers, non-modifiable individual-level factors had the greatest influence on PA. The limited success of this and previous studies to identify modifiable determinants and the finding that most preschoolers were sufficiently active suggest that future attempts should provide insights into how preschoolers' activity levels can be maintained and fostered to prevent subsequent harmful declines attributable, amongst others, to educational transitions. Thus, good-quality longitudinal studies are needed.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

Obsessive-compulsive disorder and the risk of subsequent mental disorders: A community study of adolescents and young adults

BACKGROUND

Comorbidity of obsessive-compulsive disorder (OCD) with other mental disorders has been demonstrated repeatedly. Few longitudinal studies, however, have evaluated the temporal association of prior OCD and subsequent mental disorders across the age period of highest risk for first onset of mental disorders. We examined associations between prior OCD and a broad range of subsequent mental disorders and simulated proportions of new onsets of mental disorders that could potentially be attributed to prior OCD, assuming a causal relationship.

METHODS

Data from 3,021 14- to 24-year-old community subjects were prospectively collected for up to 10 years. DSM-IV OCD and other DSM-IV mental disorders were assessed with the Munich-Composite International Diagnostic Interview. We used adjusted time-dependent proportional hazard models to estimate the temporal associations of prior OCD with subsequent mental disorders.

RESULTS

Prior OCD was associated with an increased risk of bipolar disorders (BIP; [hazard ratio, HR = 6.9, 95% confidence interval, CI, (2.8,17.3)], bulimia nervosa [HR = 6.8 (1.3,36.6)], dysthymia [HR = 4.4 (2.1,9.0)], generalized anxiety disorder (GAD; [HR = 3.4 (1.1,10.9)], and social phobia [HR = 2.9 (1.1,7.7)]). Of these outcome disorders, between 65 and 85% could be attributed to OCD in the exposed group, whereas between 1.5 and 7.7% could be attributed to OCD in the total sample.

CONCLUSIONS

This study provides strong evidence that prior OCD is associated with an increased risk of subsequent onset of BIP, bulimia nervosa, dysthymia, GAD, and social phobia among adolescents and young adults. Future studies should evaluate if early treatment of OCD can prevent the onset of these subsequent mental disorders.

Relevance of the Thought-Shape Fusion Trait Questionnaire for healthy women and women presenting symptoms of eating disorders and mixed mental disorders

Thought-shape fusion (TSF) describes the experience of marked concerns about body weight/shape, feelings of fatness, the perception of weight gain, and the impression of moral wrongdoing after thinking about eating fattening/forbidden foods. This study sets out to evaluate the short version of the TSF trait questionnaire (TSF). The sample consists of 315 healthy control women, 244 women with clinical and subthreshold eating disorders, and 113 women with mixed mental disorders (mixed). The factor structure of the TSF questionnaire was examined using exploratory and subsequent confirmatory factor analyses. The questionnaire distinguishes between a Concept scale and a Clinical Impact scale. However, a lack of measurement invariances refers to significant differences between groups in terms of factor loadings, thresholds, and residuals, which questions cross-group validity. Results indicate that the concept is understood differently in the 3 groups and refers to the suitability of the questionnaire primarily for individuals presenting with symptoms of eating disorders.

Cognitive Distortions Associated with Imagination of the Thin Ideal: Validation of the Thought-Shape Fusion Body Questionnaire (TSF-B)

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709.

Patterns of older and younger prisoners' primary healthcare utilization in Switzerland

Purpose The purpose of this paper is to identify primary health concerns prompting older and younger prisoners in Switzerland to consult a nurse or a general practitioner (GP) within the prison healthcare setting, and explores if these reasons for visits differ by age group (49 years and younger vs 50 years and older). The authors used 50 years and older as the benchmark for older prisoners in light of literature indicating accelerated aging among prisoners. Design/methodology/approach Retrospective information from medical records of 406 prisoners were collected for a period of six months. This study analyzed the reasons for which prisoners visited the nurses and GPs available to them through the prison healthcare service. These reasons were coded using the International Classification of Primary Care-version 2. Data were analyzed descriptively and four generalized linear models were built to examine whether there was an age group difference in reasons for visiting nurses and GPs. Findings The health reasons for visiting nurses and GPs by 380 male prisoners from 13 Swiss prisons are presented. In the six month period, a total of 3,309 reasons for visiting nurses and 1,648 reasons for visiting GPs were recorded. Prisoner participants' most common reasons for both visits were for general and unspecified complaints and musculoskeletal problems. Older prisoners sought significantly more consultations for cardiovascular and endocrine problems than younger prisoners. Research limitations/implications Nurses play an important role in addressing healthcare demands of prisoners and coordinating care in Swiss prisons. In light of age-related healthcare demands, continuing education and training of both nurses and GPs to adequately and efficiently address the needs of this prisoner group is critical. Allowing prisoners to carry out some care activities for minor self-manageable complaints will reduce the demand for healthcare. Originality/value This study presents unique data on healthcare concerns for which prisoners visit prison nurses and GPs. It highlights the varied needs of older prisoners as well as how these needs are addressed based on the availability of the primary healthcare provider within the prison.

The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention

Background/Objective: Prolonged stress can overwhelm coping resources, leading people to seek mental health care. Acceptance and commitment therapy (ACT) is an intervention that enhances well-being and reduces distress, assumedly by means of increasing psychological flexibility (PF). We examined the association between a total increase in PF during an intervention and decreases in stress and increases in well-being during and after the intervention. Method: The intervention was a randomized controlled trial of an ACT-based self-help intervention. Participants were 91 individuals reporting elevated levels of work-related stress. Measurements were completed at preintervention, postintervention, and 3-month follow-up. Results: Structural equation models revealed that the total increase in PF during the intervention was negatively associated with a decrease in stress (b = -0.63, SE = 0.14, p < .001) and positively associated with an increase in well-being during the intervention (b = 0.48, SE = 0.11, p < .001), but not with a decrease in stress (b = 0.03, SE = 0.27, p > .05) and well-being (b = -0.04, SE = 0.39, p > .05) following the intervention. Conclusions: Our study provides empirical support for decreasing stress and promoting well-being through ACT and emphasizes the potential of PF in promoting well-being.

Acceptance of a structured diagnostic interview in children, parents, and interviewers

The objective of this study was to investigate the satisfaction and acceptance of a structured diagnostic interview in clinical practice and in a research setting. Using the Structured Diagnostic Interview for Mental Disorders in Children and Adolescents (Kinder-DIPS), 28 certified interviewers conducted 202 interviews (115 with parents, 87 with children). After each interview, children, parents, and interviewers completed a questionnaire assessing the overall satisfaction (0 = not at all satisfied to 100 = totally satisfied) and acceptance (0 = completely disagree to 3 = completely agree) with the interview. Satisfaction ratings were highly positive, all means >82. The mean of the overall acceptance for children was 2.43 (standard deviation [SD] = 0.41), 2.54 (SD = 0.33) of the parents, 2.30 (SD = 0.43) of the children's interviewers, and 2.46 (SD = 0.32) of the parents' interviewers. Using separate univariate regression models, significant predictors for higher satisfaction and acceptance with the interview are higher children's Global Assessment of Functioning, fewer number of children's diagnoses, shorter duration of the interview, a research setting, female sex of the interviewer, and older age of the interviewer. Results indicate that structured diagnostic interviews are highly accepted by children, parents, and interviewers. Importantly, this is true for different treatment settings.

Daily fluctuation of emotions and memories thereof: Design and methods of an experience sampling study of major depression, social phobia, and controls

Symptom fluctuations and the dynamic contexts provoking these are poorly understood. This deficit is compounded by people's limited ability to accurately report about such dimensions in retrospect. Utilizing the advantages of experience sampling methodology (ESM), this study rigorously describes and tests proximal environmental, neurobiological and psychological factors associated with symptoms and mood states. Participants were assigned to three diagnostic groups: Major Depressive Disorder (MDD; n = 118), Social Phobia (SP; n = 47), or a Control Group without SP or MDD (CG; n = 119). Laboratory assessments included cognitive abilities, memory, constructs, and brain derived neurotrophic factor (BDNF). ESM lasted seven days, with six assessments per day covering symptoms, affect, daily events, social interactions, post-event processing, well-being, etc. Morning cortisol and actigraphy were also assessed during ESM. Thereafter, participants provided subjective retrospective recall estimates of the emotions they reported during ESM. The multi-level data of >10,000 observations will allow for thorough examination of fluctuations of psychopathology and well-being in two highly prevalent disorders. Using two clinical groups and a non-affected control group, the clinical specificity versus generalizability of processes can be directly tested, thus providing stimulating information about the overlap and differences between anxiety and affective disorders. This research informs about the development, fluctuation, and maintaining factors of emotions and symptoms and examines the accuracy with which participants recall these dimensions.

Contralateral Associated Movements Correlate with Poorer Inhibitory Control, Attention and Visual Perception in Preschool Children

Contralateral associated movements (CAMs) frequently occur in complex motor tasks. We investigated whether and to what extent CAMs are associated with inhibitory control among preschool children in the Swiss Preschoolers' Health Study. Participants were 476 healthy, typically developing children (mean age = 3.88 years; 251 boys) evaluated on two consecutive afternoons. The children performed the Zurich Neuromotor Assessment, the statue subtest of the Neuropsychological Assessment for Children (NEPSY), and cognitive tests of the Intelligence and Development Scales-Preschool (IDS-P). CAMs were associated with poor inhibitory control on the statue test and poor selective attention and visual perception on the IDS-P. We attributed these findings to preschoolers' general immaturity of the central nervous system.

A prospective study of associations among helping, health, and longevity

How does helping behavior contribute to the health and the longevity of older helpers? From an evolutionary perspective, the ultimate cause may be rooted in ancestral parenting and grandparenting. These activities may have generalized to a neural and hormonal caregiving system that also enabled prosocial behavior beyond the family. From a psychological perspective, helping others may be associated with healthy aging, which, in turn, contributes to longevity as a proximate cause. Yet little is known about the extent to which mediating factors such as the health benefits of helping behaviors translate into enhanced longevity, particularly in regard to grandparenting. To fill this gap, we conducted mediation analyses (structural equation models) to examine whether grandparenting and supporting others in the social network contributed directly or indirectly (through better health 5-6 years later) to the longevity of older helpers. We drew on longitudinal data from the Berlin Aging Study (N = 516), in which older adults in Berlin, Germany, were interviewed at baseline (1990-1993, mean age at entry = 85 years) and continuously followed up until 2009. Results suggest that the associations of both grandparenting and supporting others with enhanced longevity are mediated by better prospective health (indirect effect). The effect of helping was not fully mediated, however-helping was also directly associated with increased longevity independently of the health indicators measured. The results were robust against effects of the helper's preexisting health status and sociodemographic characteristics of participants, their children, and grandchildren. We conclude that better prospective health contributes to the link between helping and longevity, but does not fully account for it. Other potential contributing mechanisms remain to be identified. As populations age across the globe, identifying mechanisms that foster health in old age can help to highlight potential targets for public health interventions.