Fear of Death in Colombian Nursing Students

Introduction: Death is a natural phenomenon inherent to the human condition and an inevitable consequence of life. As future professionals, nursing students should face the process of death and recognize their limitations, because emotional aspects can influence the quality of health care, especially in Spanish-speaking countries. This study aimed to quantify the level of fear of death among nursing students in a higher education institution in a region of Colombia. Methods: A quantitative correlational study including 258 university students selected by stratified sampling were administered the Collet-Lester Fear of Death Scale; the results were analyzed for the age, religion, marital status, number of children, and academic level of the respondents. Results: On average, the students were 22.9 years old; 83.3% of them were female, 75.6% were Catholic, 14.1% had at least one child, and 66.7% had experienced bereavement in the family. An association was found between the female gender and the fear of one's own death (p = .025). Conclusion: These findings differ from those reported in other Latin American countries where higher academic level and clinical experience are related to lower fear of death.

Visual metaphor of sadness in poetry comics: a socio-cognitive perspective

Earlier literature on conceptual metaphor studies has extensively examined verbal metaphors of sadness in different text types and with cultural variations. However, there has been by far limited research on the visual metaphor of sadness. Adopting a socio-cognitive perspective, this study investigates the conceptual metaphor of sadness in the exemplary case of Chinese poetry comics drawn by Cai Zhizhong. The findings reveal that (1) BEING SAD IS BEING CONFRONTED WITH NATURAL FORCE and BEING SAD IS BEING PHYSICALLY ISOLATED are the two most frequently occurring visual metaphors across the panels; (2) all the visual metaphors at play can be explained according to the conceptual metaphor theory; (3) SADNESS IS BITTERSWEET FOOD OR DRINK and BEING SAD IS BEING PHYSICALLY ISOLATED are two additional kinds of sadness metaphors identified; and (4) the visual metaphors of sadness with Chinese cultural variations are rooted in mainstream Chinese cultural philosophies in the relevant period of history. The article also discusses the underlying mechanisms of the investigated visual metaphors in the Chinese culture by unveiling three cultural characteristics in the particular context.

The voices of youths in COVID-19 times: exploring young people's emotional representations

Since the spread of the COVID-19 virus worldwide, the pandemic had psychological consequences for the entire population for various reasons including restrictions, isolation, and socioeconomic changes. Young people were particularly affected by these psychological consequences, which formed the focus of the mental health concerns voiced by the World Health Organization. This research aimed to analyze, first-hand, the primary emotions that COVID-19 evoked in young Spanish people after two years of the pandemic. Participants were recruited through a snowball sampling procedure using emails, virtual platforms of the schools, and social networks, and a google forms questionnaire was administered for data collection. A total of 479 Spanish young people (18-36 years) participated in this study. The questionnaire consisted of a free-association exercise based on the Grid Elaboration Method (GEM) to analyze the participants' emotional representations of COVID-19. In addition, lexical analysis was used to analyze the text corpus. As a result, it could be observed that sadness was the core emotion experienced among young people, followed by fear. Specifically, emotional breakdown, fear, fatigue, and anger figured centrally in their emotional representations. Moreover, the findings revealed new patterns of self- and onward blaming towards youths. It was concluded that results of this research provide important clues for managing the mental health of young people, particularly during future pandemics.

Conflicts hurt: social stress predicts elevated pain and sadness after mild inflammatory increases

ABSTRACT

Individuals respond differently to inflammation. Pain, sadness, and fatigue are common correlates of inflammation among breast cancer survivors. Stress may predict response intensity. This study tested whether breast cancer survivors with greater exposure to acute or chronic social or nonsocial stress had larger increases in pain, sadness, and fatigue during an acute inflammatory response. In total, 156 postmenopausal breast cancer survivors (ages 36-78 years, stage I-IIIA, 1-9 years posttreatment) were randomized to either a typhoid vaccine/saline placebo or the placebo/vaccine sequence, which they received at 2 separate visits at least 1 month apart. Survivors had their blood drawn every 90 minutes for the next 8 hours postinjection to assess levels of interleukin-6 and interleukin-1 receptor antagonist (IL-1Ra). Shortly after each blood draw, they rated their current levels of pain, sadness, and fatigue. Women also completed the Test of Negative Social Exchange to assess chronic social stress and the Trier Inventory of Chronic Stressors screen to index chronic general stress. At each visit, a trained experimenter administered the Daily Inventory of Stressful Events to assess social and nonsocial stress exposure within the past 24 hours. After statistical adjustment for relevant demographic and behavioral covariates, the most consistent results were that survivors who reported more chronic social stress reported more pain and sadness in response to IL-1Ra increases. Frequent and ongoing social stress may sensitize the nervous system to the effects of inflammation, with potential implications for chronic pain and depression risk among breast cancer survivors.

Effects of the COVID-19 pandemic on mental health, working, and life situation of employees in the Swedish hospitality industry

Introduction

Previous studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike several other countries, Sweden never enforced a lockdown. Restaurants, bars, and hotels could remain open and host a limited number of guests but had to abide by certain restrictions.

Methods

A cross-sectional survey was distributed among hospitality industry employees containing questions regarding the perceived effects of the pandemic on the respondents' working and life situations and their physical and psychological health. The sample consisted of 699 individuals, with a response rate of 47.9%.

Results

Although several respondents had been laid off or furloughed, the majority of the sample remained at the same employer. However, more than half of the respondents reported that their economic situation had deteriorated. Compared to before the pandemic, 38.1% experienced elevated levels of stress, 48.3% experienced elevated levels of worry, and 31.4% reported worsened mood. A deteriorating personal economy and difficulty in following COVID-19-related restrictions at work were associated with the worsening of these three mental health aspects. While the fear of becoming infected with COVID-19 was related to higher levels of stress, the fear of infecting others was related to higher levels of worry.

Conclusion

Although Sweden imposed less strict measures than most other countries, the personal economy and mental health of hospitality workers were negatively affected by the COVID-19 pandemic.

Robots with tears can convey enhanced sadness and elicit support intentions

The behaviour of shedding tears is a unique human expression of emotion. Human tears have an emotional signalling function that conveys sadness and a social signalling function that elicits support intention from others. The present study aimed to clarify whether the tears of robots have the same emotional and social signalling functions as human tears, using methods employed in previous studies conducted on human tears. Tear processing was applied to robot pictures to create pictures with and without tears, which were used as visual stimuli. In Study 1, the participants viewed pictures of robots with and without tears and rated the intensity of the emotion experienced by the robot in the picture. The results showed that adding tears to a robot's picture significantly increased the rated intensity of sadness. Study 2 measured support intentions towards a robot by presenting a robot's picture with a scenario. The results showed that adding tears to the robot's picture also increased the support intentions indicating that robot tears have emotional and social signalling functions similar to those of human tears.

ERP evidence for emotion-specific congruency effects between sentences and new words with disgust and sadness connotations

Introduction

The present study investigated how new words with acquired connotations of disgust and sadness, both negatively valenced but distinctive emotions, modulate the brain dynamics in the context of emotional sentences.

Methods

Participants completed a learning session in which pseudowords were repeatedly paired with faces expressing disgust and sadness. An event-related potential (ERP) session followed the next day, in which participants received the learned pseudowords (herein, new words) combined with sentences and were asked to make emotional congruency judgment.

Results

Sad new words elicited larger negative waveform than disgusting new words in the 146-228 ms time window, and emotionally congruent trials showed larger positive waveform than emotionally incongruent trials in the 304-462 ms time window. Moreover, the source localization in the latter suggested that congruent trials elicited larger current densities than incongruent trials in a number of emotion-related brain structures (e.g., the orbitofrontal cortex and cingulate gyrus) and language-related brain structures (e.g., the temporal lobe and the lingual gyrus).

Discussion

These results suggested that faces are an effective source for the acquisition of words' emotional connotations, and such acquired connotations can generate semantic and emotional congruency effects in sentential contexts.

On the beauty of sadness: it's okay to say, I am sad, thank you

We live in times when our culture is obsessed with happiness. The value of almost every aspect of our lives is increasingly judged in terms of their contribution to our happiness. Happiness has become the ultimate goal by which values and priorities are constructed and the only thing for which any action in pursuit of does not require justification. In contrast, sadness is increasingly abnormalized and pathologized. In this paper, an effort is made to counteract the narrative that sadness, a critical aspect of human life is abnormal or a pathological condition. The evolutionary benefits of sadness and its place in human flourishing are discussed. A rebranding of sadness is proposed that emphasizes the free expression of sadness in everyday greetings to remove it from its current negative state and promote many of its benefits including post-traumatic growth and resilience.

The buffering role of social support on the severity of physical symptoms among patients living with cancer

BACKGROUND

The role of perceived social support (the individual's perception that family, friends and others are available as psychological, social and material support) and its moderating effect on the psychological and physical factors among patients suffering medical problems is still debated.

AIM

To explore the effect of perceived social support on the relationship between psychological and health-related factors on the severity of physical symptoms among patients with cancer.

METHODS

A descriptive-correlational, cross-sectional design was used to recruit 459 patients with cancer from three major hospitals in Jordan. Data were collected using a self-administered questionnaire.

RESULTS

Social support was significantly correlated to the severity of physical symptoms (p>.05) among patients with cancer, while psychological distress, sadness, disturbed body image and anxiety were not (p<.05). The multiple hierarchal regression model showed that social support has no significant moderation effect on the relationship between psychological and health-related factors and the severity of physical symptoms controlling for sociodemographic factors among patients with cancer.

CONCLUSION

Patients with cancer suffering physical and psychological disturbances do not benefit from social support as a way of controlling the severity of their symptoms. Palliative nurses need to tailor a social support intervention to their patients with cancer, in order to use both professional and family resources.

Naïve Theories of Emotions: Why People Might (Not) Be Uncertain or in Conflict About Felt Emotions

Beliefs about conflict and uncertainty over felt emotions-for Joy, Pride, Sadness, Jealousy and Envy events-were studied by means of Yes/No and Why questions. Each participant (N = 1,156) judged a typical antecedent for a single emotion-e.g., Jealousy: story protagonist SP sees his or her partner kiss someone. The Yes/No results showed that SP was frequently expected to experience both phenomena, the more so the greater the event impact (Yes range: 40-86%). Beliefs associated with Yes answers (BY) were categorized into 4 categories: (BY1) reason-emotion opposition-felt emotions are unreasonable, inadequate ways of reacting; (BY2) ambivalent emotions-e.g., joy and sadness; (BY3) unclear emotions; (BY4) other causes-e.g., focused on event implications, SP's personality. No conflict or uncertainty answers (BN; range 14-60%) mirrored BY categories: (BN1) no reason-emotion opposition, (BN2) no ambivalent emotions, (BN3) clear emotions, (BN4) other causes. Attributions and beliefs about causes did not generally differ by gender. As a collective entity, expressed beliefs were complex, focusing on one or more emotion component-e.g., appraisal, regulation, expression-as well as on emotion intensity, duration, and on self-concept issues. Overall, expressed beliefs seemed to imply a malleability theory of emotions, and emotion awareness. Results overall confirmed the hypotheses that conflict and uncertainty attributions are more likely for: unpleasant experiences; when emotions are norm-incongruent for the judged event; when mixed, ambivalent emotions are felt. The study confirms that people interpret emotion processes according to their lay theories.

Silent Tears of Midwives: 'I Want Every Mother Who Gives Birth to Have Her Baby Alive'-A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania

BACKGROUND

Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being.

RESEARCH AIMS

To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings.

METHODS

Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted.

RESULTS AND DISCUSSION

Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns.

CONCLUSIONS

Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings.

Facial emotion recognition in adolescent depression: The role of childhood traumas, emotion regulation difficulties, alexithymia and empathy

Introduction

Facial emotion recognition (FER) is crucial for effective social competency, and problems in this skill are linked depression during adolescence. In this study, we aimed to find the rates of FER accuracy for negative (fearful, sad, angry, disgusted), positive (happy, surprised), and neutral emotions, and the possible predictors of FER skill for most confusing emotions.

Subjects and Methods

A total of 67 drug-naive adolescents with depression (11 boys, 56 girls; 11-17 years) were recruited for the study. The facial emotion recognition test, childhood trauma questionnaire and basic empathy, difficulty of emotion regulation, and Toronto alexithymia scales were used.

Results

The analysis demonstrated that adolescents have more difficulties in recognizing negative emotions when compared the positive ones. The most confusing emotion is fear (39.8% of fear was recognized as surprise). Boys have lower fear recognition skill than girls and higher childhood emotional abuse, physical abuse, emotional neglect, and difficulty in describing feelings to predict lower fear recognition skill. For sadness recognition skill, emotional neglect, difficulty in describing feelings, and depression severity were the negative predictors. Emotional empathy has a positive effect on disgust recognition skill.

Conclusion

Our findings demonstrated that impairment of FER skill for negative emotions is associated with childhood traumas, emotion regulation difficulties, alexithymia, and empathy symptoms in adolescent depression.

Reflections on Losing My Office during the Pandemic

Reflections on loss, grief, and the possibility of recovery after losing my office, my analyst's office, and my analyst during the pandemic. The role of an office in consolidating a sense of analytic identity and the usefulness of sadness in catalyzing change are discussed.

Defensive emotions and evaluative judgements: Sensitivity to anger and fear predicts moral judgements, whereas sensitivity to disgust predicts aesthetic judgements

Aesthetic and moral evaluations engage appetitive and defensive emotions. While the role played by pleasure in positive aesthetic and moral judgements has been extensively researched, little is known about how defensive emotions influence negative aesthetic and moral judgements. Specifically, it is unknown which defensive emotions such judgements tap into, and whether both kinds of judgement share a common emotional root. Here, we investigated how participants' individual sensitivity to disgust, fear, anger and sadness predicted subjective judgements of aesthetic and moral stimuli. Bayesian modelling revealed that participants who were more sensitive to anger and fear found conventional and moral transgressions more wrong. In contrast, participants who were more sensitive to disgust disliked asymmetrical geometric patterns and untidy rooms more. These findings suggest that aesthetic and moral evaluations engage multiple defensive emotions, not just disgust, and that they may rely on different defensive emotions as part of their computational mechanism.

The Effect of Sadness on Visual Artistic Creativity in Non-Artists

The study of the relationships between mood and creativity is long-standing. In this study, the effects of mood states on artistic creativity were investigated in ninety non-artist participants. Mood states were induced by instructing participants to listen to self-selected happy, sad, or neutral music for ten minutes. Then, all participants were asked to make two artistic drawings. To check for mood manipulation, the Profile of Mood States (POMS) was administered before and after listening to the self-selected music. After the mood induction, the negative group reported higher scores than the other two groups in the 'depression' subscale and lower scores than the other two groups in the 'vigour' subscale of the POMS; the positive mood group showed more vigour than the negative mood group. Yet, three independent judges assigned higher ratings of creativity and emotionality to the drawings produced by participants in the negative mood group than drawings produced by participants in the other two groups. These results confirmed that specific negative mood states (e.g., sadness) positively affect artistic creativity, probably because participants are more likely to engage in mood-repairing. Limitations and future research directions are presented.

Color features continuously represent negative and positive aspects of sadness

Emotion is assumed to be stored in long-term memory as a concept by a feature (e.g., "tears" for "sadness") that is a memory unit of a concept. Memory activation of emotion concepts via features is supposed to enable recognition of emotional states. Emotion concepts are associated with various perceptual features oriented toward the interior and exterior of the body. Although previous studies have revealed that internal perceptual features need to recognize emotional experiences, how external perceptual features contribute to memory representation of emotions is unclear. This study focused on sadness and aimed to identify how color, which is an external perceptual feature, represents sadness in long-term memory. We hypothesized that colors continuously represent positive and negative aspects of sadness. Participants rated the congruency between each of 99 color visual stimuli and five major emotions, six sadness-related situations, and five psychological properties. Consistent with the prediction, two bluish color groups appeared to represent sadness based on emotional congruency ratings. Colors with the highest sadness ratings were related to dark and dull bluish ones. On the other hand, lighter bluish colors mixed with green appearance were similarly congruent with both sadness and happiness. The lightness properties of these sadness-related bluish colors continuously represent sadness dominancy (sadness rating minus happiness rating). Additionally, sadness dominancy of each sadness-related color group was differently associated with sadness-related situations. These findings indicate that color features contribute to memory representation of sadness in association with situations and that color features continuously instantiate negative and positive aspects of sadness.

Youth baseline and state pain-related injustice appraisals are associated with emotional responses of anger and sadness: An experimental study

Background

Youth pain-related injustice appraisals are associated with adverse functioning; however, mechanisms by which injustice appraisals exert their impact have yet to be elucidated. Adult injustice literature suggests anger, sadness, and attention bias to anger (AB) as potential mechanisms. This study examined the effects of injustice appraisals in a healthy youth sample by applying a justice violation manipulation. We hypothesized the justice violation condition to lead to worse pain outcomes with effects mediated by anger, sadness, and AB as compared to the control condition. We further explored associations between both baseline and state injustice appraisals and anger, sadness, and AB across conditions.

Methods

A 2 × 2 time by condition design was used to test hypotheses. 133 healthy youth aged 9-16 years old completed two cold pressor tasks (CPTs). In the experimental (i.e., justice violation) group, participants were initially told to complete one CPT, but were told afterwards to perform it again due to experimenter negligence. In the control group, no justice violation occurred. Baseline injustice appraisals and pain catastrophizing were assessed with the Injustice Experience Questionnaire and Pain Catastrophizing Scale for Children; state outcomes (i.e., injustice, catastrophizing, anger, sadness) were assessed after CPTs. AB was indexed using a dot-probe task.

Results

Findings indicated no effects of the justice violation on pain outcomes or associated mechanisms, nor on injustice appraisals, suggesting manipulation failure. However, across conditions, baseline and state injustice appraisals were positively associated with anger and sadness, but not with AB.

Conclusions

Despite the experimental justice violation failing to elicit differential injustice appraisals across conditions, the current study supports both anger and sadness as key emotional responses associated with pain-related injustice appraisals in a healthy youth sample.

PDSTD - The Portsmouth Dynamic Spontaneous Tears Database

The vast majority of research on human emotional tears has relied on posed and static stimulus materials. In this paper, we introduce the Portsmouth Dynamic Spontaneous Tears Database (PDSTD), a free resource comprising video recordings of 24 female encoders depicting a balanced representation of sadness stimuli with and without tears. Encoders watched a neutral film and a self-selected sad film and reported their emotional experience for 9 emotions. Extending this initial validation, we obtained norming data from an independent sample of naïve observers (N = 91, 45 females) who watched videos of the encoders during three time phases (neutral, pre-sadness, sadness), yielding a total of 72 validated recordings. Observers rated the expressions during each phase on 7 discrete emotions, negative and positive valence, arousal, and genuineness. All data were analyzed by means of general linear mixed modelling (GLMM) to account for sources of random variance. Our results confirm the successful elicitation of sadness, and demonstrate the presence of a tear effect, i.e., a substantial increase in perceived sadness for spontaneous dynamic weeping. To our knowledge, the PDSTD is the first database of spontaneously elicited dynamic tears and sadness that is openly available to researchers. The stimuli can be accessed free of charge via OSF from https://osf.io/uyjeg/?view_only=24474ec8d75949ccb9a8243651db0abf .

Emotional impact on children during home confinement in Spain

Introduction

The COVID-19 pandemic has brought about important changes. On March 14, 2020, a strict home confinement was decreed in Spain. Children did not attend school and were not allowed to leave their homes. The aim of this study was to determine the emotional state of these children, as well as associated factors.

Material and methods

A cross-sectional descriptive study was conducted using an online questionnaire sent by cell phone. This survey includes sociodemographic items and questions concerning the emotional impact of the lockdown. With the questions on emotions, two categories of emotional state were established with the variables fear, irritability, sadness and somatization: those who were less or more emotionally affected. A multivariate logistic model was used to estimate the associations between the variables.

Results

A total of 3,890 responses were obtained. The mean age of the children was 6.78 years (range 0 to 16). A score indicating poor emotional state was reported by 40.12%. The multivariate logistic model for poor emotional state was directly associated with having less appetite, sleep disturbances, and with parents' beliefs that their child will have difficulties returning to normal life after lockdown. A better emotional state was associated with being an only child, access to outdoor spaces at home, having pets, and parents informing their children about the pandemic using creative explanations.

Conclusions

During strict home confinement, a considerable emotional impact was observed in children as described by their parents. Specific elements were associated with a better or poorer emotional state.

The effect of cognitive reappraisal and expression suppression on sadness and the recognition of sad scenes: An event-related potential study

Previous studies have found differences in the cognitive and neural mechanisms between cognitive reappraisal and expression suppression in the regulation of various negative emotions and the recognition of regulated stimuli. However, whether these differences are valid for sadness remains unclear. As such, we investigated the effect of cognitive reappraisal and expression suppression on sadness regulation and the recognition of sad scenes adopting event-related potentials (ERPs). Twenty-eight healthy undergraduate and graduate students took part in this study. In the regulation phase, the participants were asked to down-regulation, expressive suppression, or maintain their sad emotion evoked by the sad images, and then to perform an immediately unexpected recognition task involving the regulated images. The behavioral results show that down-regulation reappraisal significantly diminished subjective feelings of sadness, but expressive suppression did not; both strategies impaired the participants' recognition of sad images, and expressive suppression had a greater damaging effect on the recognition of sad images than down-regulation reappraisal. The ERP results indicate that reappraisal (from 300 ms to 1,500 ms after image onset) and expressive suppression (during 300-600 ms) significantly reduced the late positive potential (LPP) induced by sadness. These findings suggest that down-regulation reappraisal and expression suppression can effectively decrease sadness, and that down-regulation reappraisal (relative to expression suppression) is a more effective regulation strategy for sadness. Both strategies impair the recognition of sad scenes, and expression suppression (compared to down-regulation reappraisal) leads to relatively greater impairment in the recognition of sad scenes.

Can Ponies (Equus Caballus) Distinguish Human Facial Expressions?

Communication within a species is essential for access to resources, alerting to dangers, group facilitation and social bonding; human facial expressions are considered to be an important factor in one’s ability to communicate with others. Evidence has shown that dogs and horses are able to distinguish positive and negative facial expressions by observing photographs of humans, however there is currently no research on how facial expressions from a live human are perceived by horses. This study investigated how ponies distinguish facial expressions presented by live actors. Trained actors (n = 2), using the human Facial Action Coding System, displayed four facial expressions (anger, sadness, joy and neutral) individually to twenty ponies. Heart rate and behaviors of the ponies including first monocular eye look, eye look duration (right and left side bias) and latency to approach were observed. A generalized linear mixed model (GLIMMIX) using Sidak’s multiple comparisons of least squared means determined that when exposed to anger expressions ponies looked more often with their left eye first and when exposed to joy, looked more often with their right eye first (p = 0.011). The ponies spent more time looking at angry expressions (p = 0.0003) in comparison to other expressions. There was no variation in heart rate across expressions (p > 0.89). Regardless of human facial expression, ponies looked longer (p = 0.0035), took longer to approach (p = 0.0297) and displayed more oral behaviours (p < 0.0001) with one actor than the other indicating increased arousal or negative valence. Ponies with more experience as a lesson mount had lower heart rates (p < 0.0001) carried their head lower (p < 0.0001), kept their left ear on the actor (p < 0.03) and exhibited more oral behaviours (p < 0.0001) than ponies with less experience. This study demonstrates that ponies are able to distinguish facial expressions presented by a live human, but other factors also contribute to their responses to humans.

Evolution of Posttraumatic Symptoms and Related Factors in Healthcare Workers During the COVID-19 Pandemic: A Longitudinal Study

OBJECTIVE

This study aimed to (1) evaluate the evolution of mental health (posttraumatic stress symptoms [PTSSs], depression, and burnout) of healthcare workers during the second wave of the pandemic (November to December 2020) and compare it with the first wave (March to May 2020), and (2) ascertain the predictors of PTSSs.

METHODS

In March to May 2020 (T1), 269 healthcare professionals working in Spain completed PTSSs, sadness, resilience, and coping questionnaires. In November to December 2020 (T2, N = 58), we assessed PTSSs, sadness, burnout, and depression.

RESULTS

Among the healthcare professionals, 63.8% displayed severe PTSSs, 51.7% depressive symptoms, and 79.3% emotional exhaustion (T2). Some risk factors were caring for patients who were severely ill or dying and using rumination, thinking avoidance, self-isolation, emotional expression, and self-blaming as coping strategies.

CONCLUSIONS

The pandemic has had a deep and long-lasting impact on the healthcare workers' mental health.

The Ham-D is not Hamilton's Depression Scale

Introduction

This article will demonstrate that the most widely used versions of the Hamilton Rating Scale for Depression (HAM-D) used in randomized clinical trials, the Guy 1976 HAM-D¹ and the SIGH-D,² have response options that deviate sharply from Max Hamilton's 1960³ and 1967⁴ guidelines. For example, difficulty in concentration, one of the diagnostic criteria for a Major Depressive Episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1980, in editions III, IV, IV-TR and 5,⁵ is something that Hamilton wrote should be measured in his scale, yet it is not measured in either of the presently used HAM-Ds.

Method

A review was conducted of the four key papers related to the development of the Hamilton Rating Scale for Depression: the 1960 and 1967 papers by Max Hamilton; the HAM-D chapter in the 1976 ECDEU Assessment Manual for Psychopharmacology edited by William Guy; and the 1988 article on the Structured Interview Guide for the HAM-D (SIGH-D) by Janet Williams. Additionally, the Janet Williams updated 2013 SIGH-D⁶ is also reviewed.

Results

When comparing the HAM-D and the SIGH-D with the gold standard Hamilton guidelines from his 1960 and 1967 articles, 13 of the 17 items contain significant errors.

Conclusion

Significant differences between the currently used HAM-Ds and the guidelines set forth by Max Hamilton in 1960 and 1967 will be demonstrated. These discrepancies may produce inconsistencies in administration and scoring, leading to unreliable measurements of subjects' and patients' depressive symptoms and unreliable measurement of their progress over time.

Degree of Meaningfulness of an Event's Ending Can Modulate Mixed Emotional Experiences Among Japanese Undergraduates

While people may experience mixed emotions when confronting a meaningful ending; it is unclear how much an ending's meaningfulness contributes to evoking these mixed emotions. This study examined, among Japanese undergraduate students, whether different degrees of meaningfulness of an ending affected emotional experiences, and how time passage changed emotional intensity. Sixty-one Japanese students (37 females, 24 males; M age = 20.75, SD = 0.80) reported their emotional experiences and the degree of meaningfulness they assigned to the ending of the Heisei era at two time points-before and after the ending. As expected, participants who placed high meaningfulness to the ending of the Heisei era experienced a high level of mixed emotions, indicating that the degree of meaningfulness given to an ending can modulate emotional experiences. Furthermore, the specific emotions experienced (i.e., sadness or happiness) differed depending on the assessment time point, such that the meaningfulness of the ending played a key role in producing mixed emotional experiences in this sample.

Moved by Social Justice: The Role of Kama Muta in Collective Action Toward Racial Equality

Participation in collective action is known to be driven by two appraisals of a social situation: Beliefs that the situation is unfair (injustice appraisal) and beliefs that a group can change the situation (collective efficacy appraisal). Anger has been repeatedly found to mediate the relationship between injustice appraisals and collective action. Recent work suggests that the emotion of being moved mediates the relationship between efficacy appraisals and collective action. Building on this prior work, the present research applies kama muta theory to further investigate the relationship between efficacy appraisals and collective action. Kama muta is a positive emotion that is evoked by a sudden intensification of communal sharing, and largely overlaps with the English concept being moved. We investigated its relationship with collective action in both advantaged and disadvantaged racial groups in the context of the Black Lives Matter Movement (BLM) in Spring of 2020. In one pilot study (N = 78) and one main study (N = 215), we confirmed that anger toward the system of racial inequalities mediated between injustice and collective action intentions, and that kama muta toward the movement mediated between collective efficacy and collective action intentions. Both mediations were found for both Black and White participants. We also observed additional unpredicted paths from anger to kama muta and from efficacy to anger. Together, this provides evidence for the pivotal role of emotions in collective action intentions, but also points out that appraisals need to be better understood.

Impact of Induced Moods, Sensation Seeking, and Emotional Contagion on Economic Decisions Under Risk

In addition to probabilities of monetary gains and losses, personality traits, socio-economic factors, and specific contexts such as emotions and framing influence financial risk taking. Here, we investigated the effects of joyful, neutral, and sad mood states on participants' risk-taking behaviour in a simple task with safe and risky options. We also analysed the effect of framing on risk taking. In different trials, a safe option was framed in terms of either financial gains or losses. Moreover, we investigated the effects of emotional contagion and sensation-seeking personality traits on risk taking in this task. We did not observe a significant effect of induced moods on risk taking. Sad mood resulted in a slight non-significant trend of risk aversion compared to a neutral mood. Our results partially replicate previous findings regarding the presence of the framing effect. As a novel finding, we observed that participants with a low emotional contagion score demonstrated increased risk aversion during a sad mood and a similar trend at the edge of significance was present in high sensation seekers. Overall, our results highlight the importance of taking into account personality traits of experimental participants in financial risk-taking studies.

Interactive Effects of Coping Strategies and Emotion Dysregulation on Risk for Peer Victimization

The aim of the current longitudinal study was to examine the interactive effects of six common coping strategies (i.e., adult support seeking, friend support seeking, problem solving, humor, passive coping, and cognitive distancing) and emotion (i.e., anger and sadness) dysregulation on concurrent levels and subsequent trajectories of peer victimization over a 2-year period. Participants were 287 predominantly Caucasian students (53.7% boys; ages 6-9) from an elementary school located in the Midwestern United States. Self-reported coping strategies and emotion dysregulation were assessed at baseline; children also provided ratings of peer victimization annually over a 2-year period. Results indicated that the effectiveness of particular coping strategies may depend on children's overt, undercontrolled displays of anger and sadness. Consistent with recent recommendations, these findings suggest that some youth may require interventions that focus on both enhancing emotion regulation skills and teaching strategies for responding to peer victimization in a more adaptive manner.

Emotional processing of sadness and disgust evoked by disaster scenes

OBJECTIVE

Disaster scenes produce long-term negative feelings in those who experience them. Previous studies have focused on mitigating disaster impacts through directed forgetting or conscious suppression. However, the initial emotional processing of disaster scenes is not fully understood, hindering the comprehension of long-term disaster impacts. This study aims to investigate how pictures of disaster scenes evoking disgust and sadness are processed via cortical electrical activity.

METHODS

Pictures of grief and mutilation from disasters were used to evoke sadness and disgust, respectively. Event-related desynchronization (ERD) and event-related potentials (ERPs) were used to quantify the intensity and time-course of emotional processing.

RESULTS

The information processing of emotional pictures was stronger than neutral pictures, represented by greater declines of alpha ERD. In the posterior ERP components of N1 and EPN, amplitudes for emotional pictures were larger than those for neutral pictures, which reflected the effects of arousal on visual perception. In the anterior ERP components of P2, P3, and LPP, disgust pictures showed higher attention attraction and enhanced encoding memory processing.

CONCLUSIONS

Disgust disaster scenarios induced long-term prominent LPP, which may correspond with the long-term negative impacts of the disaster.

Can't fight seeing sadness in tears: Measuring the implicit association between tears and sadness

Visible tears have been shown to enhance the perception of sadness. Whether the sadness perception from visible tears can occur automatically, which is essential for the rapid identification of emotional cues in real-life social interactions, is still unclear. We employed the reaction-time-based Implicit Association Test (IAT) to assess the implicit association of tears and sadness in two studies. Study 1 (N = 58) used sadness/non-sadness or negative/positive affect words as attribute pairs and images of tearless or tearful neutral expressions as targeted concepts. In Study 2 (N = 54), the neutral expressions were replaced with anger, disgust, fear, surprise, and happiness expressions with or without tears. Both studies revealed a strong tendency among participants to implicitly associate tears with sadness and negative affect. The results complemented findings from self-report measures by showing that the perception of sadness from visible tears can occur efficiently with little control.

Differences in genetic counseling student responses to intense patient affect: A study of students in North American programs

Research indicates genetic counseling patients often experience intense emotions. No studies, however, have investigated how genetic counseling students respond to patient affect. This survey study investigated student responses to patient emotions and select factors affecting their responses. One-hundred fifty-one genetic counseling students in North American programs wrote a response to each of three hypothetical prenatal scenarios, identical except for the patient affect expressed (anger, fear, or sadness). They also completed measures of empathy tendency and tolerance of negative affect and demographic questions. Multivariate analysis of covariance (MANCOVA), used to analyze the effects of major study variables on the types of responses given by participants, was significant. Follow-up univariate ANCOVAs indicated small to moderate effect sizes for student clinical experience, race/ethnicity, and relationship status within and across scenarios. For example, as number of patients counseled increased, participants used more feeling reflections and fewer self-involving statements. There were no significant differences in responses due to empathy tendency or affect tolerance. Most common responses were information provision and feeling reflections for the Anger scenario, information provision for the Fear scenario, and influencing responses for the Sadness scenario. Responses to each scenario typically involved multiple thoughts (range: 1-14; means ranged from 3.25 in the Sadness scenario to 3.62 in the Fear scenario). Most students (82%) reported the Anger scenario was the most difficult. Thematic analysis of reasons a scenario was difficult yielded four themes: Discomfort with situation/emotion, Positive countertransference, Uncertain how to respond, and Negative countertransference. Findings that clinical experience affects how participants responded to patient affect support the essential role of applied experience. Findings also support training and supervision to help genetic counseling students in North America learn ways to respond to strong patient emotions and recognize and manage countertransference.

Being moved by listening to unfamiliar sad music induces reward-related hormonal changes in empathic listeners

Many people enjoy sad music, and the appeal for tragedy is widespread among the consumers of film and literature. The underlying mechanisms of such aesthetic experiences are not well understood. We tested whether pleasure induced by sad, unfamiliar instrumental music is explained with a homeostatic or a reward theory, each of which is associated with opposite patterns of changes in the key hormones. Sixty-two women listened to sad music (or nothing) while serum was collected for subsequent measurement of prolactin (PRL) and oxytocin (OT) and stress marker (cortisol and adrenocorticotropic hormone) concentrations. Two groups of participants were recruited on the basis of low and high trait empathy. In the high empathy group, PRL and OT levels were significantly lower with music compared with no music. And compared to the low empathy group, the high empathy individuals reported an increase of positive mood and higher ratings of being moved with music. None of the stress markers showed any changes across the conditions or the groups. These hormonal changes, inconsistent with the homeostatic theory proposed by Huron, exhibit a pattern expected of general reward. Our findings illuminate how unfamiliar and low arousal music may give rise to pleasurable experiences.

Loneliness and psychological distress in everyday life among Latinx college students

OBJECTIVE

Changes in surroundings and social relationships may heighten feelings of loneliness, suggesting the need to measure as a state. This study tested whether loneliness fluctuates within and across days and the resultant associations with psychological distress. Further it tested familism as a moderator as endorsing this cultural value may buffer the negative effects of state loneliness.

PARTICIPANTS

Participants (n = 220) were Latinx undergraduate students.

METHODS

Students reported their loneliness levels and psychological distress twice a day for two weeks using an ecological momentary assessment approach.

RESULTS

Results showed that experiencing a higher than usual level of loneliness predicted greater sadness, stress, and anxiety at both the moment-to-moment and day-to-day level. Familism, measured at baseline, only moderated the relationship between loneliness and sadness.

CONCLUSIONS

The findings suggest being in a lonely moment may lead to the initiation or amplification of psychological distress immediately and the effects may linger over the day.Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1927051.

The Differential Effects of Anger and Sadness on Intertemporal Choice: An ERP Study

Previous research has taken a valence-based approach to examine the carryover effects of incidental emotions on intertemporal choices. However, recent studies have begun to explore the effects of specific emotions on intertemporal choices. In this study, we investigated how anger and sadness influenced intertemporal choices using event-related potentials (ERPs). Behavioral results showed that, compared with neutral prime, anger prime was associated with more preference for delayed rewards, whereas sad prime did not change individuals’ choice preference. Specifically, anger prime yielded a shorter response time than sad prime for the difficult-to-select choices. ERP results found that, compared with neutral and sad primes, anger prime elicited larger P1 in the fronto-central and parietal areas, larger P2 in the fronto-central area, and larger P3 in the parietal area during the evaluation stage. These findings suggest that there are differential carryover effects of anger and sadness on intertemporal choice. This study provides enlightenment on the significance of understanding how incidental emotions affect individuals’ intertemporal choices.

The effect of anger on intentionality bias

More than a decade of research on emotions has demonstrated the role of affect in social judgments. Emotions influence the way individuals make inferences about others' behavior. Building on these previous findings, the present research investigates the effects of anger and sadness on the attribution of intentionality. In Experiment 1, angry, sad, or neutral participants read a series of sentences describing simple actions and had to indicate whether the actions were done intentionally or accidentally. Results showed that anger significantly predicted the proportion of intentional judgment when participants were asked to interpret ambiguous sentences. In Experiment 2, the effect of anger on intentionality was replicated. Angry participants endorsed more intentional explanations than neutral participants. This finding helps explain how anger increases the inclination to make hostile inferences.

Happy Enough to Relax? How Positive and Negative Emotions Activate Different Muscular Regions in the Back - an Explorative Study

Embodiment theories have proposed a reciprocal relationship between emotional state and bodily reactions. Besides large body postures, recent studies have found emotions to affect rather subtle bodily expressions, such as slumped or upright sitting posture. This study investigated back muscle activity as an indication of an effect of positive and negative emotions on the sitting position. The electromyography (EMG) activity of six back muscles was recorded in 31 healthy subjects during exposure to positive and negative affective pictures. A resting period was used as a control condition. Increased muscle activity patterns in the back were found during the exposure to negative emotional stimuli, which was mainly measured in the lumbar and thorax regions. The positive emotion condition caused no elevated activity. The findings show that negative emotions lead to increased differential muscle activity in the back and thus corroborate those of previous research that emotion affects subtle bodily expressions.

Sadness and Other Health Complaints among Swedish Adolescents: A Cross-Sectional Study

Health complaints are increasing among adolescents and are recognized as a global public health issue. Health complaints are an indicator for subjective ill-being, but little is known about the relationship between sadness and other health complaints. The aim of this study was to investigate sadness and other health complaints among Swedish adolescents. A survey with a cross-sectional design was completed by adolescents (n = 1489, 15-17 years old) in the south of Sweden. A logistic regression analysis was used to analyze the relationship between sadness and other health complaints. The result show that sadness and other health complaints were common among adolescents, and sadness was related to health complaints (headache (OR: 1.58), sleeping difficulties (OR: 2.00), reduced appetite (OR: 1.43), tension (OR: 2.44), and concentration difficulties (OR: 2.75)). When adolescents express sadness or other health complaints it is important to reflect on what these complaints are an expression of, and take into account the body as physical and psychological intertwined. This might entail person-centered support that hopefully leads to an improvement in adolescents' well-being. Future research that profoundly highlights adolescents' existential health is needed.

The influence of sad mood induction on task performance and metacognition

In many situations, the ability to make appropriate metacognitive judgements on our performance is essential to make decisions and adapt our behaviour. Past research suggests a strong relationship between metacognition and emotional disorders such as depression. Depressive disorders have been associated with an underestimation bias: depressive patients report lower confidence in their performance than healthy individuals. It is currently not clear whether the induction of a negative mood in healthy participants has similar consequences. Yet, such knowledge would permit to isolate the causal influence of the negative affect on metacognition, free of all the comorbidities associated with depression. In this study, we used a combination of films, pictures, and recalls to induce negative and neutral moods during a perceptual metacognitive task. Negative mood induction had no impact on the perceptual task. Participants did report lower confidence levels in the negative condition compared with a neutral condition. This study thus confirms a causal relationship between negative affect and metacognitive abilities.

Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial

Background

Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats.

Objective

This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation.

Methods

All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry.

Results

The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation.

Conclusions

Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions.

Trial Registration

ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Epidemiology of Fear, Sadness, and Anger Expression in Palliative Care Conversations

CONTEXT

Advancing the science of serious illness communication requires methods for measuring characteristics of conversations in large studies. Understanding which characteristics predict clinically important outcomes can help prioritize attention to scalable measure development.

OBJECTIVES

To understand whether audibly recognizable expressions of distressing emotion during palliative care serious illness conversations are associated with ratings of patient experience or six-month enrollment in hospice.

METHODS

We audiorecorded initial palliative care consultations involving 231 hospitalized people with advanced cancer at two large academic medical centers. We coded conversations for expressions of fear, anger, and sadness. We examined the distribution of these expressions and their association with pre/post ratings of feeling heard and understood and six-month hospice enrollment after the consultation.

RESULTS

Nearly six in 10 conversations included at least one audible expression of distressing emotion (59%; 137 of 231). Among conversations with such an expression, fear was the most prevalent (72%; 98 of 137) followed by sadness (50%; 69 of 137) and anger (45%; 62 of 137). Anger expression was associated with more disease-focused end-of-life treatment preferences, pre/post consultation improvement in feeling heard and understood and lower six-month hospice enrollment. Fear was strongly associated with preconsultation patient ratings of shorter survival expectations. Sadness did not exhibit strong association with patient descriptors or outcomes.

CONCLUSION

Fear, anger, and sadness are commonly expressed in hospital-based palliative care consultations with people who have advanced cancer. Anger is an epidemiologically useful predictor of important clinical outcomes.

Identifying Emotional Expressions: Children's Reasoning About Pretend Emotions of Sadness and Anger

This study aims to further understand children’s capacity to identify and reason about pretend emotions by analyzing which sources of information they take into account when interpreting emotions simulated in pretend play contexts. A total of 79 children aged 3 to 8 participated in the final sample of the study. They were divided into the young group (ages 3 to 5) and the older group (6 to 8). The children were administered a facial emotion recognition task, a pretend emotions task, and a non-verbal cognitive ability test. In the pretend emotions task, the children were asked whether the protagonist of silent videos, who was displaying pretend emotions (pretend anger and pretend sadness), was displaying a real or a pretend emotion, and to justify their answer. The results show significant differences in the children’s capacity to identify and justify pretend emotions according to age and type of emotion. The data suggest that young children recognize pretend sadness, but have more difficulty detecting pretend anger. In addition, children seem to find facial information more useful for the detection of pretend sadness than pretend anger, and they more often interpret the emotional expression of the characters in terms of pretend play. The present research presents new data about the recognition of negative emotional expressions of sadness and anger and the type of information children take into account to justify their interpretation of pretend emotions, which consists not only in emotional expression but also contextual information.

Movement Behaviors and Perceived Loneliness and Sadness within Alaskan Adolescents

Physical activity, screen use, and sleep are behaviors that integrate across the whole day. However, the accumulative influence of meeting recommendations for these 24-h movement behaviors on the mental health of Alaskan adolescents has not been examined. The purpose of this study was to examine the associations between movement behaviors, loneliness, and sadness within Alaskan adolescents. Data were obtained from the 2019 Alaska Youth Risk Behavior Survey (YRBS). The number of adolescents participating in the 2019 Alaska YRBS was 1897. Associations between meeting recommendations for movement behaviors with loneliness and sadness were examined using weighted logistic regression models, adjusted for age, sex, race/ethnicity, and body mass index (BMI). Approximately 5.0% of the sample met recommendations for all three movement behaviors. Meeting 2 or 3 movement behavior recommendations was associated with lower odds of loneliness (odds ratio (OR) range = 0.23 to 0.44, p < 0.01). Additionally, meeting 1 to 3 movement behavior recommendations was associated with lower odds of sadness (OR range = 0.29 to 0.52, p < 0.05). Joint association analyses determined that these relationships were primarily driven by meeting the sleep recommendation for loneliness and meeting the screen use recommendation for sadness. The results support use of multiple movement-based behavior programming to attenuate feelings of loneliness and sadness within Alaskan adolescents.

A Temporal Network Approach to Paranoia: A Pilot Study

Paranoid beliefs have been conceptualized as a central psychological process linked to schizophrenia and many mental disorders. Research on paranoia has indicated that it is pivotal to consider not only levels but also dynamic aspects of incriminated related mechanisms over time. In the present study, we conceptualized paranoia as a system of interacting elements. To do so, we used temporal network analysis to unfold the temporal dynamics between core psychological paranoia-related mechanisms, such as self-esteem, sadness, feeling close to others, and experiential avoidance. Time-series data of 23 participants with high scores in paranoia and/or interpersonal sensitivity were collected via experience sampling methodology (ESM). We applied a multilevel vector autoregressive (mlVAR) model approach and computed three distinct and complementary network models (i.e., contemporaneous, temporal, and between-subject) to disentangle associations between paranoia-related mechanisms in three different time frames. The contemporaneous model indicated that paranoia and sadness co-occurred within the same time frame, while sadness was associated with both low self-esteem and lack of closeness to others. The temporal model highlighted the importance of feeling close to others in predicting low paranoia levels in the next time frame. Finally, the between-subject model largely replicated an association found in both contemporaneous and temporal models. The current study reveals that the network approach offers a viable data-driven methodology for elucidating how paranoia-related mechanisms fluctuate over time and may determine its severity. Moreover, this novel perspective may open up new directions toward identifying potential targets for prevention and treatment of paranoia-related problems.

High School Students: Results From the 2017 Youth Behavior Risk Survey

For this study, we explored the association between high school students' reported history of sport- or physical activity-related concussions and persistent feelings of sadness or hopelessness. Data from the 2017 national Youth Risk Behavior Survey (YRBS; N = 14,765) was used for this analysis. YRBS is administered to high school students throughout the country every 2 years. Findings from this study demonstrate that the prevalence of persistent feelings of sadness or hopelessness was 36.4% among students who reported sustaining one or more concussions. Compared to students who did not report having sustained a concussion, the odds of persistent feelings of sadness or hopelessness were significantly higher among students who had sustained one or more concussions (AOR = 1.41). These findings support the need for continued efforts by school nurses and other health care providers to identify students with a history of concussion and assess their mental health needs.

Negative Impact of Sadness on Response Inhibition in Females: An Explicit Emotional Stop Signal Task fMRI Study

Response inhibition is a critical cognitive ability underlying executive control over reactions to external cues, or inner requirements. Previous studies suggest that high arousal negative emotions (e.g., anger or fear) could impair response inhibition in implicit emotional stop signal tasks (eSSTs). However, studies exploring how low arousal negative emotions (e.g., sadness) influence response inhibition remain sparse. In the current study, 20 female college students performed an explicit eSST to explore the influence of sadness on response inhibition and its neural mechanism. Participants are instructed to press a button to sad or neutral facial stimuli while inhibiting their response during the presentation of a stop signal. Results showed that compared with neutral stimuli, sad stimuli were related to increased stop signal reaction time (SSRT) (i.e., worse response inhibition). Compared with neutral condition, higher activation during sad condition was found within the right superior frontal gyrus (SFG), right insula, right middle cingulate cortex (MCC), bilateral superior temporal gyrus (STG), left lingual gyrus, and right motor cortex. These findings indicated that sadness, like other negative emotions, may impair response inhibition in an explicit way and highlight the explicit eSST as a new paradigm to investigate the subtle interaction between negative emotion processing and cognitive control.

Identifying Positive Features of the Sadness Prototype

Sadness, an emotional experience of daily life, is typically associated with negative experiences such as the loss of a loved one. However, sadness also has an adaptive function, as it can help us respond appropriately to environmental demands. While previous research has revealed positive functions of sadness, it is unclear whether laypeople recognize any positive aspects of sadness. In the present three-part study, we aimed to identify whether laypeople conceptualize any positive features of sadness. In Part 1, we asked Japanese participants (n = 122) to describe the features of "sadness," and their responses revealed 37 different sadness features, some of which were assumed to be positive aspects (e.g., meaning making). In Part 2, we asked a second group of Japanese participants (n = 140) to rate the centrality of each previously named feature, and we then classified the features into either central or peripheral sadness features. At this point, participants reported positive aspects of sadness (e.g., co-occurrence of positive emotion). To confirm the differences between central and peripheral features, in Part 3 we examined automatic responses toward these features from a third group of Japanese participants (n = 91) and demonstrated the relationship between the concept of sadness and its characteristic features. We presented these participants with a subset of the features of sadness and then asked them to complete a recall and recognition task. As expected, they recalled central features more often than peripheral features of sadness, and they generated false recognitions to central features. In conclusion, this three-part study indicated that there are positive features related to the function of sadness that laypeople can identify in their mental lexicon.

On the Enjoyment of Sad Music: Pleasurable Compassion Theory and the Role of Trait Empathy

Drawing on recent empirical studies on the enjoyment of nominally sad music, a general theory of the pleasure of tragic or sad portrayals is presented. Not all listeners enjoy sad music. Multiple studies indicate that those individuals who enjoy sad music exhibit a particular pattern of empathic traits. These individuals score high on empathic concern (compassion) and high on imaginative absorption (fantasy), with only nominal personal distress (commiseration). Empirical studies are reviewed implicating compassion as a positively valenced affect. Accordingly, individuals who most enjoy sad musical portrayals experience a pleasurable prosocial affect (compassion), amplified by empathetic engagement (fantasy), while experiencing only nominal levels of unpleasant emotional contagion (commiseration). It is suggested that this pattern of trait empathy may apply more broadly, accounting for many other situations where spectators experience pleasure when exposed to tragic representations or portrayals.

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Background.

Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions.

Methods.

Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression.

Results.

After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms.

Conclusions.

In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.

Better insight seems associated with depressive symptoms in schizophrenia.

Network analyses were used to explore this association in a large sample.

Insight was associated with self-depreciation, guilt, and suicidal ideation.

Although cross-sectional, data suggest causal direction from insight to depression.

Symptoms in Children Receiving Treatment for Cancer-Part II: Pain, Sadness, and Symptom Clusters

Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child's quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children's Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.

Hypoactivity in the Paraterminal Gyrus Following Bilateral Anterior Capsulotomy

OBJECTIVE

Bilateral anterior capsulotomy (BAC) is one of the ablative neurosurgical procedures used to treat major depressive disorder or obsessive-compulsive disorder when all other therapies fail. Tristolysis, a reduction in sadness, is the most striking clinical effect of BAC and is seen in the first 1 to 2 weeks after surgery. This retrospective study measured regional cerebral blood flow (rCBF) following surgery to identify which cortical regions were impacted and could account for this clinical effect.

METHODS

All patients had their capsulotomies done in Vancouver by the same team. Pre- and postoperative single-photon emission computed tomography perfusion scans were analyzed for 10 patients with major depressive disorder and 3 with obsessive-compulsive disorder. rCBF was measured semiquantitatively by calculating the ratio between an identified region of interest and a whole brain reference area.

RESULTS

Decreased rCBF was found in the paraterminal gyri. Increased rCBF was found in the dorsolateral prefrontal cortices and in the left lateral temporal lobe.

CONCLUSIONS

BAC causes hypoactivity in the paraterminal gyri and is the most likely explanation for its tristolytic effect, suggesting that the paraterminal gyrus is the limbic cortical locus for the emotion of sadness. Increased activity in the dorsolateral prefrontal cortices may be occurring via connectional diaschisis, and suppression by overactive paraterminal gyri during depression may account for some of the neurocognitive deficits observed during depressive episodes.

Physiological, behavioral and subjective sadness reactivity in frontotemporal dementia subtypes

Frontotemporal dementia (FTD), a neurodegenerative disease broadly characterized by socioemotional impairments, includes three clinical subtypes: behavioral variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA) and non-fluent variant primary progressive aphasia (nfvPPA). Emerging evidence has shown emotional reactivity impairments in bvFTD and svPPA, whereas emotional reactivity in nfvPPA is far less studied. In 105 patients with FTD (49 bvFTD, 31 svPPA and 25 nfvPPA) and 27 healthy controls, we examined three aspects of emotional reactivity (physiology, facial behavior and subjective experience) in response to a sad film. In a subset of the sample, we also examined the neural correlates of diminished aspects of reactivity using voxel-based morphometry. Results indicated that all three subtypes of FTD showed diminished physiological responding in respiration rate and diastolic blood pressure; patients with bvFTD and svPPA also showed diminished subjective experience, and no subtypes showed diminished facial behavior. Moreover, there were differences among the clinical subtypes in brain regions where smaller volumes were associated with diminished sadness reactivity. These results show that emotion impairments extend to sadness reactivity in FTD and underscore the importance of considering different aspects of sadness reactivity in multiple clinical subtypes for characterizing emotional deficits and associated neurodegeneration in FTD.