Hazardous Drinking Mediates the Relation Between Externalizing Personality and Reduced Adherence to COVID-19 Public Health Guidelines in University Students

Using a multigroup path analysis, we examined if hazardous alcohol use mediated the relations between elevated externalizing personality traits (i.e., impulsivity or sensation seeking) and reduced adherence to COVID-19 public health guidelines. We hypothesized that those high in externalizing personality traits would demonstrate less adherence to public health guidelines and that hazardous alcohol use would mediate this relationship. First- and second-year undergraduates (N = 1232; ages 18-25) from five Canadian universities participated in a cross-sectional survey between January to April 2021. Individuals with higher levels of impulsive or sensation seeking personality traits demonstrated poorer adherence to COVID-19 public health guidelines and these relations were mediated by hazardous alcohol use. Results suggest that hazardous drinking is an important target for students high in impulsivity and sensation seeking to increase their adherence to public health guidelines and thereby help control viral spread.

Evaluating the effectiveness of compensatory memory interventions in adults with acquired brain injury: A systematic review and meta-analysis of memory and everyday outcomes

OBJECTIVE

Adults with acquired brain injury (ABI) often experience memory impairments that are persistent and difficult to treat. Although evidence has shown that rehabilitation programs may improve cognitive performance in persons with ABI, there is an opportunity to look more closely at the benefits provided by specific interventions. We conducted a systematic review and meta-analysis to evaluate whether compensation-based memory programs improve memory or everyday outcomes (e.g., mood, quality of life, community integration, everyday functioning).

METHOD

The review was limited to published, English-language controlled trials that evaluated compensatory memory interventions for adults (18 +) with ABI using at least one memory or everyday outcome. The final search was conducted in April 2021 using PsychINFO, Medline, EMBASE, the Cochrane Review database, Google Scholar, and the reference lists of relevant articles.

RESULTS

Of 2,817 identified articles, 22 controlled trials met inclusion criteria, of which 12 provided sufficient data to include in the meta-analyses. Risk of bias assessment identified problems with recruitment and masking procedures. Results indicate that compared to controls, these interventions produce positive effects on outcomes of immediate verbal recall (g = 0.43), participant-reported memory (g = 0.28), and strategy use (g = 0.39) and that these improvements are maintained at follow-up.

CONCLUSIONS

Compensatory memory programs produce meaningful memory improvements and are a promising avenue for reducing ABI-related memory impairment. Future research focusing on specific subsets of ABI populations and a broader range of participant-reported outcomes is needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sex differences in maladaptive emotional and behavioral responses to COVID-19: What is the role of personality?

Males are more non-adherent to public health measures for containing COVID-19 while females experience more COVID-19-related distress. Personality traits may influence both non-adherence and distress. We examined sensation seeking (SS), anxiety sensitivity (AS), impulsivity, and hopelessness as traits potentially associated with non-adherence and distress in response to COVID-19. Furthermore, we sought to understand if known sex differences in SS (male > female) and AS (female > male) may explain sex differences on these two COVID-19 outcomes. In the first month of the pandemic, 400 adults (mean age = 32.16 years; 45.3%F) completed the Substance Use Risk Profile Scale to assess personality. Degree of adherence to public health recommendations and COVID-19-related distress were also measured. Male sex was indirectly related to poorer adherence to stay-at-home advisories via SS, and female sex was indirectly related to higher COVID-19 distress via AS. Personality-targeted interventions may help reduce non-adherence and COVID-19 distress, potentially reducing sex differences.

The Role of Perceived Social Support in the Association Between Stressful Life Events and Suicidal Behavior

Background: Suicide is a serious public health concern for which there have been well-established protective and risk factors reported in literature. There is a lack of evidence on the indirect effects of other variables on these factors. Specifically, the association between stressful life events and suicidal behavior may be affected by perceived social support, but its role in this association is largely uninvestigated. Objectives: Thus, this paper aims to explore the role of perceived social support in the association between stressful life events and suicidal behavior. Perceived social support will be explored as a mediator and as a moderator in this association. Methods: Data were obtained from the Determinants of Suicidal Behavior Conventional and Emergent Risk (DISCOVER), a study conducted to identify risk factors of suicidal behavior. The study participants are individuals with suicide attempts admitted to hospital. Participants (n = 343) were recruited from hospital setting. Suicidal behavior was measured using two outcomes (1) the occurrence of a suicide attempt (2) level of suicide intent as measured by the Pierce Suicide Intent Scale. Perceived social support was measured using the Sarason Social Support Questionnaire. Results: Stressful life events were significantly associated with suicide attempts (OR 1.440, 95% CI 1.440, 1.682, p < 0.001) and perceived social support (B -0.785, 95% CI -1.501, -0.068, p = 0.032). There was no significant mediation effect by perceived social support in the association between stressful life events and suicide attempts (Sobel's test statistic 1.64, p = 0.100). Perceived social support did not moderate the relationship between stressful life events and suicide attempts [(OR 1.007, 95% CI 0.987, 1.027, p = 0.514] or the relationship between stressful life events and level of suicidal intent (B -0.043, 95% CI -0.132, 0.046, p = 0.343). Conclusion: Stressful life events are associated with increased risk of suicide attempts. The study also identified an inverse relationship between stressful life events and perceived social support. These associations were independent of perceived social support. This study highlights the effects of stressful life events on suicide risk is not affected by perceived social support, requiring further investigation into measures to reduce the impact of social stressors on people with risk of suicide.

Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis

OBJECTIVE

Prescription opioid misuse has led to a new cohort of opioid use disorder (OUD) patients who were introduced to opioids through a legitimate prescription. This change has caused a shift in the demographic profile of OUD patients from predominantly young men to middle age and older people. The management of OUD includes medication-assisted treatment (MAT), which produces varying rates of treatment response. In this study, we will examine whether the source of first opioid use has an effect on treatment outcomes in OUD. Using a systematic review of the literature, we will investigate the association between source of first opioid introduction and treatment outcomes defined as continuing illicit opioid use and poly-substance use while in MAT.

METHODS

Medline, EMBASE, CINHAL, and PsycInfo were searched from inception to December 31st, 2019 inclusive using a comprehensive search strategy. Five pairs of reviewers conducted screening and data extraction independently in duplicate. The review is conducted and reported according to the PRISMA guidelines. A random-effects model was used for meta analyses assuming heterogeneity among the included studies.

RESULTS

The initial search results in 27,345 articles that were screened, and five observational studies were included in the qualitative and quantitative analyses. Our results found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while on MAT. They were also less likely to use cannabis (0.54, 95% CI 0.32, 0.89), alcohol (0.75, 95% CI 0.59, 0.95), cocaine (0.50, 95% CI 0.29, 0.85), and injection drug use (0.25, 95% CI 0.14, 0.43) than those introduced to opioids through recreational means.

CONCLUSION

This study shows that the first exposure to opioids, whether through a prescription or recreationally, influences prognosis and treatment outcomes of opioid use disorder. Although the increased pattern of prescribing opioids may have led to increased OUD in a new cohort of patients, these patients are less likely to continue to use illicit drugs and have a different prognostic and clinical profile that requires a tailored approach to treatment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017058143.

A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder

Background

Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature.

Methods

We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment.

Results

We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials.

Conclusions

There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important.

Trial registration

PROSPERO, CRD42013006507.

Adverse Outcomes Associated with Prescription Opioids for Acute Low Back Pain: A Systematic Review and Meta-Analysis

BACKGROUND

Acute low back pain (ALBP) is a common clinical complaint that can last anywhere from 24 hours to 12 weeks. In recent years, there has been an opioid epidemic which is linked to the increased availability of prescription opioids. Though guidelines recommend that in the treatment of ALBP, opioids should be used when other treatments fail, we have seen an increase in opioid prescriptions for ALBP. With this crisis, it is important to examine if there are any adverse outcomes associated with prescribing opioids for ALBP.

OBJECTIVE

We aim to review the published literature to examine the adverse outcomes associated with opioid use for ALBP.

STUDY DESIGN

We performed a systematic review with meta-analysis in accordance with our published protocol and PRISMA guidelines.

SETTING

The review was conducted at McMaster University.

METHODS

Various electronic databases for articles published from inception to September 30, 2017, inclusive. Both randomized clinical trials and observational studies on the impact of opioid use in ALBP in the adult population were included. Eight pairs of independent reviewers performed screening, data extraction, and assessment of methodological quality. The identified articles were assessed for risk of bias using sensitivity analysis. Trials with comparative outcomes were reported in a meta-analysis using a fixed effects model.

RESULTS

A total of 13,889 studies were initially screened for the review and a total of 4 studies were included in the full review, of which 2 studies were meta-analyzed. Our results showed that prescribing opioids for ALBP was significantly associated with long-term continued opioid use (1.57, 95% CI, 1.06-2.33). There was no significant association found between unemployment duration and prescribing opioids for ALBP (3.54, 95% CI, -7.57 to 14.66).

LIMITATIONS

Due to the limited number of studies that considered unemployment, only an unpooled analysis was conducted. Among the included studies there was both statistical and clinical heterogeneity due to differences in methodology, study design, risk of selection or performance bias. Most of the studies had an unclear or high risk of bias and poorly defined side effects.

CONCLUSIONS

Due to the lack of literature examining long-term adverse outcomes associated with prescribing opioids for ALBP, no definitive conclusions can be made. However, with the literature available, there does seem to be risk associated with prescribing opioids for ALBP so there is a great need to conduct further investigations examining these adverse outcomes for ALBP patients.

KEY WORDS

Acute low back pain, opioids, prescriptions, low back pain, long-term use, opioid use disorder.