On the joys of missing data

Improving Outcome Predictions for Patients Receiving Mechanical Circulatory Support by Optimizing Imputation of Missing Values

BACKGROUND

Risk prediction models play an important role in clinical decision making. When developing risk prediction models, practitioners often impute missing values to the mean. We evaluated the impact of applying other strategies to impute missing values on the prognostic accuracy of downstream risk prediction models, that is, models fitted to the imputed data. A secondary objective was to compare the accuracy of imputation methods based on artificially induced missing values. To complete these objectives, we used data from the Interagency Registry for Mechanically Assisted Circulatory Support.

METHODS

We applied 12 imputation strategies in combination with 2 different modeling strategies for mortality and transplant risk prediction following surgery to receive mechanical circulatory support. Model performance was evaluated using Monte-Carlo cross-validation and measured based on outcomes 6 months following surgery using the scaled Brier score, concordance index, and calibration error. We used Bayesian hierarchical models to compare model performance.

RESULTS

Multiple imputation with random forests emerged as a robust strategy to impute missing values, increasing model concordance by 0.0030 (25th-75th percentile: 0.0008-0.0052) compared with imputation to the mean for mortality risk prediction using a downstream proportional hazards model. The posterior probability that single and multiple imputation using random forests would improve concordance versus mean imputation was 0.464 and >0.999, respectively.

CONCLUSIONS

Selecting an optimal strategy to impute missing values such as random forests and applying multiple imputation can improve the prognostic accuracy of downstream risk prediction models.

Do Positive Emotions Make You More Prosocial? Direct and Indirect Effects of an Intervention Program on Prosociality in Colombian Adolescents During Social Isolation Due to COVID-19

The objectives of this study are to analyze the efficacy of the Virtual Hero Program during the social isolation due to COVID-19 to increase the positive emotions (joy, gratitude, serenity, personal satisfaction, and sympathy) and prosocial behavior of Colombian adolescents. Additionally, we will analyze whether the Hero program, by directly promoting positive emotional states in adolescents, can predispose them to take prosocial actions toward other people (via an indirect or mediated effect). The final sample of the study comprised 100 participants from the intervention group (M age = 13.94, SD = 0.97) and 111 from the control group (M age = 14.39, SD = 0.81). The participants were assigned to the groups using a cluster randomized trial. The positive emotions questionnaire and the Kindness and Generosity subscale of the Values in Action Inventory of Strengths were used to measure the variables. The results indicated that the program increased joy, gratitude, serenity and personal satisfaction but not sympathy of those who participated in the intervention. The promotion of these positive emotions predisposed the Colombian adolescents to act prosocially. Furthermore, the program was also effective in directly promoting prosocial behaviors in the adolescents during social isolation, as observed through a statistically significant difference in the pre- and post-test evaluations between the control and intervention groups. The structure of the intervention brought adolescents closer to social situations to which isolation had limited their access, promoting the importance of closeness and solidarity with others within the complexities of the social confinement context. This study is particularly relevant because interventions with proven effectiveness are necessary to counteract the trauma produced by social isolation in young people throughout the world.

Comparison of Missing Data Infilling Mechanisms for Recovering a Real-World Single Station Streamflow Observation

Reconstructing missing streamflow data can be challenging when additional data are not available, and missing data imputation of real-world datasets to investigate how to ascertain the accuracy of imputation algorithms for these datasets are lacking. This study investigated the necessary complexity of missing data reconstruction schemes to obtain the relevant results for a real-world single station streamflow observation to facilitate its further use. This investigation was implemented by applying different missing data mechanisms spanning from univariate algorithms to multiple imputation methods accustomed to multivariate data taking time as an explicit variable. The performance accuracy of these schemes was assessed using the total error measurement (TEM) and a recommended localized error measurement (LEM) in this study. The results show that univariate missing value algorithms, which are specially developed to handle univariate time series, provide satisfactory results, but the ones which provide the best results are usually time and computationally intensive. Also, multiple imputation algorithms which consider the surrounding observed values and/or which can understand the characteristics of the data provide similar results to the univariate missing data algorithms and, in some cases, perform better without the added time and computational downsides when time is taken as an explicit variable. Furthermore, the LEM would be especially useful when the missing data are in specific portions of the dataset or where very large gaps of ‘missingness’ occur. Finally, proper handling of missing values of real-world hydroclimatic datasets depends on imputing and extensive study of the particular dataset to be imputed.

Planned missing data designs and methods: Options for strengthening inference, increasing research efficiency and improving animal welfare in ecological and evolutionary research

Ecological and evolutionary research questions are increasingly requiring the integration of research fields along with larger data sets to address fundamental local- and global-scale problems. Unfortunately, these agendas are often in conflict with limited funding and a need to balance animal welfare concerns. Planned missing data design (PMDD), where data are randomly and deliberately missed during data collection, combined with missing data procedures, can be useful tools when working under greater research constraints. Here, we review how PMDD can be incorporated into existing experimental designs by discussing alternative design approaches and demonstrate with simulated data sets how missing data procedures work with incomplete data. PMDDs can provide researchers with a unique toolkit that can be applied during the experimental design stage. Planning and thinking about missing data early can (1) reduce research costs by allowing for the collection of less expensive measurement variables; (2) provide opportunities to distinguish predictions from alternative hypotheses by allowing more measurement variables to be collected; and (3) minimize distress caused by experimentation by reducing the reliance on invasive procedures or allowing data to be collected on fewer subjects (or less often on a given subject). PMDDs and missing data methods can even provide statistical benefits under certain situations by improving statistical power relative to a complete case design. The impacts of unplanned missing data, which can cause biases in parameter estimates and their uncertainty, can also be ameliorated using missing data procedures. PMDDs are still in their infancy. We discuss some of the difficulties in their implementation and provide tentative solutions. While PMDDs may not always be the best option, missing data procedures are becoming more sophisticated and more easily implemented and it is likely that PMDDs will be effective tools for a wide range of experimental designs, data types and problems in ecology and evolution.

The Influence of Peer Support for Violence and Peer Acceptance of Rape Myths on Multiple Forms of Interpersonal Violence Among Youth

Significant work has highlighted the associations among physical dating violence, bullying perpetrated in person, and cyberbullying. Yet these experiences are most often examined in isolation. The present study adds to the literature by testing the hypothesis that peer factors (e.g., perceived peer support for sexual violence and perceived peer endorsement of rape myths) display associations with three forms of aggression (physical dating violence perpetration, perpetration of bullying in-person, and cyberbullying perpetration). A sample of 2,830 10th-grade youth, recruited across 27 high schools in the northeast region of the United States, completed self-report surveys assessing peer context and the perpetration of violence. To examine the potential shared risk of peer approval for sexual violence and peer endorsement of rape myths and multiple forms of violence, a multivariate extension to multilevel models (MLMs) was used. Findings suggested that as hypothesized both peer support for sexual violence and perceptions of peer endorsement of rape myths each made a significant contribution in association with dating aggression perpetration, in person bullying, as well as cyberbullying. Findings offer insight into the development of aggression in adolescence and highlight the necessity of unified research examining multiple domains together. Discussion also underscores the potential benefits of targeting peer context and perceptions of peer norms through cross-cutting prevention programming for adolescents.

Pediatric anxiety associated with altered facial emotion recognition

Multiple psychiatric disorders are associated with difficulties in facial emotion recognition. However, generalized anxiety disorder may be associated with more accurate recognition of others' emotional expressions, particularly expressions of happiness and fear, which index safety and threat. Children aged 9-14 from a community sample (N = 601) completed a facial emotion labeling task. Children's symptoms of depressive and anxiety syndromes were assessed by self- and parent-report. Elevated symptoms of generalized anxiety disorder were associated with more accurate facial emotion recognition (β = 0.16, p = 0.007), specifically recognition of happiness (β = 0.17, p = 0.002) and fear (β = 0.15, p = 0.006). Elevated depressive symptoms were associated with less accurate facial emotion recognition (β = -0.12, p = 0.018), specifically happiness (β = -0.15, p = 0.002). Elevated symptoms of separation anxiety disorder were also associated with less accurate facial emotion recognition (β = -0.16, p = 0.003), specifically happiness (β = -0.15, p = 0.006) and fear (β = -0.15, p = 0.005), which highlights the importance of distinguishing between anxiety syndromes. Results held when adjusting for child age and sex. Evidence that symptoms of generalized anxiety disorder are associated with more accurate recognition of happiness and fear is consistent with theories of heightened social vigilance and support a transdiagnostic role of facial emotion recognition that may inform the psychosocial development of youth with anxiety and depressive symptoms.

All in the family: parental substance misuse, harsh parenting, and youth substance misuse among juvenile justice-involved youth

PURPOSE

Research consistently connects parental and youth substance misuse, yet less is known about the mechanisms driving this association among justice-involved youth. We examine whether harsh parenting is an explanatory mechanism for the association between parental substance use and parental mental health and youth substance use disorder in a sample of justice-involved youth.

METHODS

Data were drawn from the Northwestern Juvenile Project, a large-scale longitudinal survey of mental health and substance misuse in a representative sample of youth in juvenile detention. Harsh parenting, child maltreatment, youth alcohol and cannabis use disorder, and parental substance misuse and mental health were assessed among 1,825 detained youth (35.95% female) at baseline, three-year follow-up, and four-year follow-up.

RESULTS

At baseline, over 80% of youth used alcohol and/or cannabis; at the four-year follow-up, 16.35% and 19.69% of the youth were diagnosed with alcohol and cannabis use disorder, respectively. More than 20% of youth reported their parent misused substances and 6.11% reported a parent had a severe mental health need. Black youth experienced significantly fewer types of harsh parenting compared to White youth. Multivariate path analyses revealed harsh parenting mediated the association between parental substance misuse and mental health on youth alcohol and cannabis use disorder. Harsh parenting that does not rise to the level of child maltreatment mediated the association between parental substance misuse and mental health on youth alcohol use disorder; in contrast, child maltreatment did not mediate these associations. Multigroup analyses revealed the effect of harsh parenting on youth alcohol and cannabis use disorder did not vary across sex or race-ethnic subgroups.

CONCLUSIONS

Harsh parenting represents one mechanism for the intergenerational continuity of alcohol and cannabis misuse and should be regularly assessed for and addressed in juvenile justice settings.

Using Motivational Interviewing to Improve Parenting Skills and Prevent Problem Behavior During the Transition to Kindergarten

In this study, we examined the efficacy of a version of the Family Check-Up (FCU) adapted for kindergarten school entry with regard to parenting skills during the transition to school. We also examined whether improvements in parenting skills would mediate improvements in parent- and teacher-rated child behavior problems from kindergarten to second grade. The FCU is a motivational interviewing (MI) intervention designed to engage parents in treatment to improve parenting skills. Participants were parents of 365 children enrolled in one of five elementary schools in the Pacific Northwestern United States. Main and indirect effects were tested with structural equation path modeling using an intent-to-treat approach. The FCU was associated with improved change in parenting skills, and changes in parenting skills, in turn, predicted reductions in child behavior problems. Implications for embedding MI in family-centered interventions at kindergarten school entry are discussed. Trial registration: NCT02289092.

Trends, Diagnoses, and Hospitalization Costs of Child Abuse and Neglect in the United States of America

We conducted a secondary analysis of the National Inpatient Sample (NIS) to examine child abuse and neglect hospitalization from 1998-2016. The NIS is the largest all-payer, inpatient care database in the United States and is maintained by the Health Care Utilization Project. Participants were youth 18 years and younger with discharged diagnoses of child abuse and neglect from hospitals. The rate of child abuse or neglect hospitalizations did not vary significantly over the study period (1998-2016), which on average was 6.9 per 100,000 children annually. Males (53.0%), infants (age < 1; 47.3%), and young children (age 1-3; 24.2%) comprised most of the child maltreatment cases. Physical abuse was the most frequent type of maltreatment leading to hospitalization. Government insurance was the most common payer source, accounting for 77.3% of all child maltreatment hospitalizations and costing 1.4 billion dollars from 2001-2016. Hospitalizations due to child abuse and neglect remain steady and are costly, averaging over $116 million per year. The burden on government sources suggests a high potential for return on investment in effective child abuse prevention strategies.

Developmental Trajectories of Pediatric Obsessive-Compulsive Symptoms

Children who experience obsessive-compulsive symptoms (OCS) may be at risk for developing Obsessive-Compulsive Disorder (OCD). The current study aimed to investigate developmental trajectories of OCS, as well as possible predictors, within a community-based sample of children. Children (N = 1147) from the longitudinal NICHD Study of Early Child Care and Youth Development (SECCYD) were assessed for OCS, via the Child Behavioral Checklist - Obsessive-Compulsive Scale (OCS-8), eight times between Pre-Kindergarten (54 months; Pre-K) and High School (15 years of age; HS.) Participants were recruited within the United States and included only maternal caregivers. Preliminary analyses indicated that approximately 3% of the sample was above the diagnostic cutoff score on the OCS-8 at the High School time-point. Latent growth models tested symptom trajectories. Findings demonstrated three groups of OCS trajectories. Most children fell within a low symptomatology group (the No Peak group) with low OCS across all time points. Two additional OCS trajectories were also demonstrated: Pre-K Peak (high to low OCS across time) and HS Peak (low to high OCS across time). Both higher attention problems and greater depression/anxiety symptoms at the Pre-K time point predicted children's membership in the Pre-K Peak or HS Peak groups compared to the No Peak group. Membership within the HS Peak group predicted a high likelihood of children's OCS being above previously established cutoff scores for an OCD diagnosis at age 15 years. Membership within either the Pre-K Peak or No Peak groups predicted a low likelihood. This study provides new evidence for the existence of different developmental trajectories for youth with OCS. From a clinical perspective, these results may have important implications when considering the identification and early intervention of childhood OCS and OCD within the community.

Evidence Lacking for Cannabis Users Slacking: A Longitudinal Analysis of Escalating Cannabis Use and Motivation among Adolescents

OBJECTIVE

Reduced motivation is often noted as a consequence of cannabis use. However, previous work has yielded mixed results and focused largely on adults. To address these limitations, this study examined longitudinal associations between cannabis use and self-reported motivation in a large adolescent sample.

METHOD

Participants were 401 adolescents aged 14-17 at baseline who completed five bi-annual assessments. We assessed motivation at three timepoints using two self-report questionnaires: the Apathy Evaluation Scale and the Motivation and Engagement Scale (disengagement, persistence, planning, self-efficacy, and valuing school subscales). Controlling for relevant covariates, we used latent growth curve modeling to characterize patterns of cannabis use and motivation over time, examining bidirectional influences between these processes.

RESULTS

On average, adolescent cannabis use frequency increased significantly over time. The disengagement and planning facets of motivation also increased significantly over time, whereas other aspects of motivation remained stable. At baseline, greater cannabis use was associated with greater disengagement, lower planning, and lower valuing of school. Greater baseline cannabis use also predicted lesser increases in disengagement over time. After controlling for the effect of sex, age, depression, and use of alcohol and nicotine, only the baseline association between cannabis use and valuing school remained significant.

CONCLUSIONS

Our results do not support a prospective link between cannabis use and reduced motivation among adolescents. Although most observed associations were accounted for by covariates, greater cannabis use was cross-sectionally associated with lower perceived value of school, which may contribute to poorer educational and later life outcomes.

Mean kids become mean adults: Trajectories of indirect aggression from age 10 to 22

Although much is known about the development of physical aggression across the lifespan, far less is known about the developmental pattern of indirect aggression from childhood to adulthood. Accordingly, we examined the self-reported use of indirect aggression from age 10 to 22 in a randomly drawn sample of 704 Canadians. A person-centered approach was used to capture intraindividual change and heterogeneity in development. Four childhood (age 10-18) indirect aggression trajectories were identified: (1) a very low decreasing group (64.8%), (2) a low decreasing group (26.0%), (3) a low-to-moderate increasing group (5.1%), and (4) a moderate increasing group (4.1%). There were more girls than boys in the moderate increasing group (75.9% vs. 24.1%). Two adulthood (age 19-22) indirect aggression trajectory groups were also identified: (1) a low decreasing group (82.6%), and (2) a moderate stable group (17.4%). No sex differences were found among adults' use across the two trajectories. When we examined the prediction of indirect aggression use in adulthood from indirect aggression use in childhood, we found that children who followed a moderate increasing trajectory from age 10 to 18 were nine times more likely to follow a moderate stable trajectory from age 19 to 22, while children who followed a low-to-moderate increasing trajectory across childhood were 14 times more likely to follow a moderate stable trajectory across adulthood (compared to the very low decreasing group). Given the negative impact indirect aggression has on others, intervening early to derail this pattern of abuse is justified.

Monitoring for the metabolic side effects of second-generation antipsychotic medications: Psychiatrists' views and practices

PURPOSE

The aims of this study were to explore (1) the knowledge, attitudes, practices, and adherence of psychiatrists in Jordan regarding published guidelines for metabolic monitoring of patients taking second-generation antipsychotics (SGAs), and (2) their perceived barriers to metabolic screening.

METHODS

The study utilized a cross-sectional survey. Data were collected from 91 psychiatrists using a self-administered questionnaire.

FINDINGS

Almost 74% of psychiatrists reported they were aware of metabolic screening guidelines for patients taking SGA. However, the results of their assessment practices revealed a lack of adherence to these guidelines. Reported barriers to metabolic screening were the financial burden on the family and lack of family and patient compliance with recommendations of monitoring.

PRACTICE IMPLICATIONS

Metabolic side effects of SGAs are important in Arab countries, where baseline levels of obesity and metabolic syndrome are already high in the general population. By virtue of their close proximity to patients, nurses are ideally placed to monitor how patients perceive SGAs and to provide information, advice, and counseling support.

Missing Data in Research on Youth and Family Programs

BACKGROUND

Multilevel data can be missing at the individual level or at a nested level, such as family, classroom, or program site. Increased knowledge of higher-level missing data is necessary to develop evaluation design and statistical methods to address it.

METHODS

Participants included 9,514 individuals participating in 47 youth and family programs nationwide who completed multiple self-report measures before and after program participation. Data were marked as missing or not missing at the item, scale, and wave levels for both individuals and program sites.

RESULTS

Site-level missing data represented a substantial portion of missing data, ranging from 0-46% of missing data at pre-test and 35-71% of missing data at post-test. Youth were the most likely to be missing data, although site-level data did not differ by the age of participants served. In this dataset youth had the most surveys to complete, so their missing data could be due to survey fatigue.

CONCLUSIONS

Much of the missing data for individuals can be explained by the site not administering those questions or scales. These results suggest a need for statistical methods that account for site-level missing data, and for research design methods to reduce the prevalence of site-level missing data or reduce its impact. Researchers can generate buy-in with sites during the community collaboration stage, assessing problematic items for revision or removal and need for ongoing site support, particularly at post-test. We recommend that researchers conducting multilevel data report the amount and mechanism of missing data at each level.

The Longitudinal Link between Organizational Citizenship Behaviors and Three Different Models of Happiness

A growing body of research conducted in general life settings has found positive associations between happiness and prosocial behavior. Unfortunately, equivalent studies in the workplace are lacking. Organizational citizenship behaviors (OCBs), the prosocial behaviors at work, have not been properly studied in relation to happiness, despite the positive consequences of both constructs for workers and companies. In response, our research aims to better understand this relationship from several angles. First, using a three-wave longitudinal design, we explored how OCBs and happiness are related to each other over time. Second, happiness was measured from a broad perspective, and three conceptualizations were adopted: the hedonic (e.g., positive affect and life satisfaction), the eudaimonic (e.g., relatedness and autonomy), and the flourishing (e.g., meaning and engagement) approaches. Thus, not only the prospective link between OCBs and happiness was tested, but it was also explored using the three models of happiness previously mentioned. Third, we conducted this longitudinal design in a less typical sample than previous research (i.e., Chile). We found results that supported our main hypotheses: (1) OCBs are prospective positive predictors of hedonic happiness, eudaimonic happiness, and flourishing; (2) the three models of happiness also prospectively predict OCBs. Our findings suggest that OCBs foster a broad range of happiness facets, which in turn fosters back the emergence of more OCBs, leading to a virtuous circle of prosociality and well-being in the workplace. This positive spiral benefits not only workers’ quality of life, but also organizations’ profitability and sustainability. Theoretical and applied implications for the field of Positive Organizational Psychology are discussed.

The Perceived Impact of COVID-19 on Comfort Food Consumption over Time: The Mediational Role of Emotional Distress

The COVID-19 pandemic has had a significant impact on populations at an economic, health, and on an interpersonal level, it is still unclear how it has affected health-risk behaviors, such as comfort food consumption over time. This study longitudinally examines the effect of the perceived impact of COVID-19 on comfort food consumption and whether this effect is mediated by emotional distress. A convenience sample of 1048 students and university staff (academic and non-academic) from two universities completed monthly online surveys during the COVID-19 pandemic across six waves (W; W1 to W6). Participants reported their perceived impact of COVID-19 (economic, interpersonal, and health), comfort food consumption, and emotional distress (DASS-21). Using structural equation models, we found an indirect longitudinal effect of the perceived impact of COVID-19 (W1) on comfort food consumption (W3 to W6) through increased emotional distress (W2). The perceived negative impact of COVID-19 on comfort food consumption was fully mediated by the emotional distress during the first waves (W3 and W4), ending in a partial mediation in the last waves (W5 and W6). These findings contribute to disentangling the mechanisms by which the perceived impact of COVID-19 affects comfort food consumption over time, and highlight the role of emotional distress. Future interventions should address comfort food consumption by focusing on handling emotional distress during a crisis.

A randomized controlled trial of instructional coaching in high-poverty urban schools: Examining teacher practices and student outcomes

Job-embedded professional development is needed to effectively and efficiently enhance teachers' use of evidence-based practices in high-poverty urban communities. This study employed a three-cohort, waitlist controlled, randomized block design to investigate the effectiveness of the Classroom Strategies Coaching Model (CSC) in 14 high-poverty urban elementary schools. The CSC Model is guided by observations of teachers' instructional and behavioral management practices as measured by the Classroom Strategies Assessment System. Primary dependent measures included teacher use of evidence-based practices, student academic engagement, and teacher ratings of class wide student academic and behavior functioning along with perceived instrumental support, emotional support, and stress. The sample included 2195 students and 106 teachers randomly assigned to CSC coaching or waitlist control. Multilevel negative binomial modeling revealed that teachers in the CSC coaching condition had significant improvements in the frequency of academic praise (used 1.74 times more frequently) and behavior praise (used 2.10 times more frequently) as compared to teachers in the waitlist control condition. Multilevel linear models revealed that, relative to the waitlist control condition, teachers in the CSC coaching condition demonstrated significant improvements in quality of instruction (d = 0.52), behavior management (d = 0.60), and class wide student academic engagement (d = 0.41). Teachers reported significant improvements in class wide student academic (d = 0.96) and behavioral functioning (d = 1.24), instrumental support (d = 0.90) and emotional support (d = 1.04). No change was found for teacher stress. Implications for research and practice are reviewed.

Patterns of family relationships in pediatric oncology: implications for children's adjustment upon treatment completion

OBJECTIVE

Family characteristics influence children's adaptation following a cancer diagnosis. Little is known about the importance of family relationships on children's social and emotional health immediately after treatment completion. In this study, we identify subtypes of family relationships and evaluate how these profiles relate to child adjustment upon treatment completion.

METHODS

Youth (N = 77; ages 7-14) who completed cancer treatment within the past 7 months provided their perceptions of their relationships with their caregivers and siblings. Caregivers and teachers rated participants' internalizing and externalizing symptoms, while participants and caregivers reported on child social and overall functioning. Latent profile analyses identified patterns of family relationships, and we examined associations between these patterns and youth outcomes.

RESULTS

A four-profile solution best characterized families as (1) low closeness/high sibling-only discord (12.4%); (2) low closeness/high discord (6.6%); (3) high closeness/low discord (47.6%); and (4) moderate closeness/moderate discord (33.4%). Family relationship profiles were differentially associated with self, caregiver, and teacher ratings of adaptation. Participants from families characterized by low closeness/high discord reported more difficulties with peer interactions than participants with high closeness/low discord in their families. Caregivers and teachers reported significantly higher externalizing symptoms for participants from low closeness/high discord and low closeness/high sibling discord families in comparison to participants with high closeness/low discord in their family.

CONCLUSIONS

Findings underscore the importance of assessing children's perceptions of family relationships in pediatric oncology and providing support to the family during and after treatment. Future directions include assessing how these profiles predict outcomes over time.

Family Relationships and Their Associations With Perceptions of Family Functioning in Mothers of Children With Intellectual Disability

We explored whether reports of three dyadic relationships (marital/partner, parent-child, sibling) were related to perceptions of family functioning in 467 mothers of children with intellectual disability aged 4-15 years. Structural equation models were fitted to examine associations between relationship indicators and family functioning. The final structural model showed that partner relationship satisfaction, partner disagreement, child-parent conflict, and sibling relationship warmth accounted for the most variance in family functioning, with partner relationship satisfaction having the strongest positive association. Dimensions of dyadic relationships appear to be associated with broader constructs of family functioning in this sample of mothers, signifying the potential for systemic intervention.

Reflection on modern methods: planned missing data designs for epidemiological research

Taking advantage of the ability of modern missing data treatments in epidemiological research (e.g. multiple imputation) to recover power while avoiding bias in the presence of data that is missing completely at random, planned missing data designs allow researchers to deliberately incorporate missing data into a research design. A planned missing data design may be done by randomly assigning participants to have missing items in a questionnaire (multiform design) or missing occasions of measurement in a longitudinal study (wave-missing design), or by administering an expensive gold-standard measure to a random subset of participants while the whole sample is administered a cheaper measure (two-method design). Although not common in epidemiology, these designs have been recommended for decades by methodologists for their benefits-notably that data collection costs are minimized and participant burden is reduced, which can increase validity. This paper describes the multiform, wave-missing and two-method designs, including their benefits, their impact on bias and power, and other factors that must be taken into consideration when implementing them in an epidemiological study design.

COVID-19 Perceived Impact and Psychological Variables as Predictors of Unhealthy Food and Alcohol Consumption Trajectories: The Role of Gender and Living with Children as Moderators

The present study examines the trajectories of unhealthy food and alcohol consumption over time and considers whether perceived impact of COVID-19 and psychological variables are predictors of these trajectories. We ascertained whether these predictors are different in women vs. men and between women living with vs. without children. Data were collected through online surveys administered to 1038 participants from two universities (staff and students) in Chile, across five waves (July to October 2020). Participants provided information about their past-week unhealthy food and alcohol consumption and mental health. Using latent growth curve modeling analysis, we found that higher perceived health and interpersonal COVID-19 impact, younger age and lower depression symptoms were associated with more rapid increases over time in unhealthy food consumption. On the other hand, higher perceived COVID-19 economic impact and older age were associated with more rapid diachronic decreases in alcohol consumption. Gender and living with or without children, for women only, were moderators of these trajectories. This longitudinal study provides strong evidence identifying the multiple repercussions of COVID-19 and mental health factors on unhealthy food and alcohol consumption. These findings highlight the need for interventions aimed at minimizing the impact of the pandemic on unhealthy food and alcohol consumption over time.

Eating behaviour, physical activity, TV exposure and sleeping habits in five year olds: a latent class analysis

BACKGROUND

Diet, physical activity, sedentary behaviours, and sleep time are considered major contributory factors of the increased prevalence of childhood overweight and obesity. The aims of this study were to (1) identify behavioural clusters of 5 year old children based on lifestyle behaviours, (2) explore potential determinants of class membership, and (3) to determine if class membership was associated with body measure outcomes at 5 years of age.

METHODS

Data on eating behaviour, engagement in active play, TV watching, and sleep duration in 1229 5 year old children from the Cork BASELINE birth cohort study was obtained through in-person interviews with parent. Latent class analysis was used to identify behavioural clusters. Potential determinants of cluster membership were investigated using multinomial logistic regression. Associations between the identified classes and cardio metabolic body measures were examined using multivariate logistic and linear regression, with cluster membership used as the independent variable.

RESULTS

51% of children belonged to a normative class, while 28% of children were in a class characterised by high scores on food avoidance scales in combination with low enjoyment of food, and 20% experienced high scores on the food approach scales. Children in both these classes had lower conditional probabilities of engaging in active play for at least 1 hour per day and sleeping for a minimum of 10 h, and higher probability of watching TV for 2 hours or more, compared to the normative class. Low socioeconomic index (SEI) and no breastfeeding at 2 months were found to be associated with membership of the class associated with high scores on the food avoidance scale, while lower maternal education was associated with the class defined by high food approach scores. Children in the class with high scores on the food approach scales had higher fat mass index (FMI), lean mass index (LMI), and waist-to-height ratio (WtHR) compared to the normative class, and were at greater risk of overweight and obesity.

CONCLUSION

Findings suggest that eating behaviour appeared to influence overweight and obesity risk to a greater degree than activity levels at 5 years old. Further research of how potentially obesogenic behaviours in early life track over time and influence adiposity and other cardio metabolic outcomes is crucial to inform the timing of interventions.

Longitudinal Trends in Childhood Insulin Levels and Body Mass Index and Associations With Risks of Psychosis and Depression in Young Adults

IMPORTANCE

Cardiometabolic disorders often occur concomitantly with psychosis and depression, contribute to high mortality rates, and are detectable from the onset of the psychiatric disorders. However, it is unclear whether longitudinal trends in cardiometabolic traits from childhood are associated with risks for adult psychosis and depression.

OBJECTIVE

To examine whether specific developmental trajectories of fasting insulin (FI) levels and body mass index (BMI) from early childhood were longitudinally associated with psychosis and depression in young adults.

DESIGN, SETTING, AND PARTICIPANTS

A cohort study from the Avon Longitudinal Study of Parents and Children, a prospective study including a population-representative British cohort of 14 975 individuals, was conducted using data from participants aged 1 to 24 years. Body mass index and FI level data were used for growth mixture modeling to delineate developmental trajectories, and associations with psychosis and depression were assessed. The study was conducted between July 15, 2019, and March 24, 2020.

EXPOSURES

Fasting insulin levels were measured at 9, 15, 18, and 24 years, and BMI was measured at 1, 2, 3, 4, 7, 9, 10, 11, 12, 15, 18, and 24 years. Data on sex, race/ethnicity, paternal social class, childhood emotional and behavioral problems, and cumulative scores of sleep problems, average calorie intake, physical activity, smoking, and alcohol and substance use in childhood and adolescence were examined as potential confounders.

MAIN OUTCOMES AND MEASURES

Psychosis risk (definite psychotic experiences, psychotic disorder, at-risk mental state status, and negative symptom score) depression risk (measured using the computerized Clinical Interview Schedule-Revised) were assessed at 24 years.

RESULTS

From data available on 5790 participants (3132 [54.1%] female) for FI levels and data available on 10 463 participants (5336 [51.0%] female) for BMI, 3 distinct trajectories for FI levels and 5 distinct trajectories for BMI were noted, all of which were differentiated by mid-childhood. The persistently high FI level trajectory was associated with a psychosis at-risk mental state (adjusted odds ratio [aOR], 5.01; 95% CI, 1.76-13.19) and psychotic disorder (aOR, 3.22; 95% CI, 1.29-8.02) but not depression (aOR, 1.38; 95% CI, 0.75-2.54). A puberty-onset major increase in BMI was associated with depression (aOR, 4.46; 95% CI, 2.38-9.87) but not psychosis (aOR, 1.98; 95% CI, 0.56-7.79).

CONCLUSIONS AND RELEVANCE

The cardiometabolic comorbidity of psychosis and depression may have distinct, disorder-specific early-life origins. Disrupted insulin sensitivity could be a shared risk factor for comorbid cardiometabolic disorders and psychosis. A puberty-onset major increase in BMI could be a risk factor or risk indicator for adult depression. These markers may represent targets for prevention and treatment of cardiometabolic disorders in individuals with psychosis and depression.

Implicit Beliefs About Emotions in Youth: Associations With Temperamental Negative Emotionality and Depression

Introduction: Individual differences in beliefs about the controllability of emotions are associated with a range of psychosocial outcomes, including depressive symptoms. Less is known, however, about factors contributing to individual differences in these beliefs. The current study examined prospective associations between negative emotionality (NE) and implicit beliefs about emotions, as well as the indirect effect of NE on depressive symptoms through implicit beliefs about emotions.

Methods: In a sample of children and adolescents, NE was assessed at baseline, implicit beliefs about emotions were assessed 18 months later, and depressive symptoms were assessed at baseline and 36 months later.

Results: NE was associated with implicit beliefs about emotions, and an indirect effect of NE on depressive symptoms through implicit beliefs about emotions was observed.

Discussion: NE represents a salient dispositional vulnerability factor contributing to individual differences in implicit beliefs about emotions, with implications for the development of depressive symptoms in youth.

Acceptance of Technologies for Aging in Place: A Conceptual Model

BACKGROUND

Older adults want to preserve their health and autonomy and stay in their own home environment for as long as possible. This is also of interest to policy makers who try to cope with growing staff shortages and increasing health care expenses. Ambient assisted living (AAL) technologies can support the desire for independence and aging in place. However, the implementation of these technologies is much slower than expected. This has been attributed to the lack of focus on user acceptance and user needs.

OBJECTIVE

The aim of this study is to develop a theoretically grounded understanding of the acceptance of AAL technologies among older adults and to compare the relative importance of different acceptance factors.

METHODS

A conceptual model of AAL acceptance was developed using the theory of planned behavior as a theoretical starting point. A web-based survey of 1296 older adults was conducted in the Netherlands to validate the theoretical model. Structural equation modeling was used to analyze the hypothesized relationships.

RESULTS

Our conceptual model showed a good fit with the observed data (root mean square error of approximation 0.04; standardized root mean square residual 0.06; comparative fit index 0.93; Tucker-Lewis index 0.92) and explained 69% of the variance in intention to use. All but 2 of the hypothesized paths were significant at the P<.001 level. Overall, older adults were relatively open to the idea of using AAL technologies in the future (mean 3.34, SD 0.73).

CONCLUSIONS

This study contributes to a more user-centered and theoretically grounded discourse in AAL research. Understanding the underlying behavioral, normative, and control beliefs that contribute to the decision to use or reject AAL technologies helps developers to make informed design decisions based on users' needs and concerns. These insights on acceptance factors can be valuable for the broader field of eHealth development and implementation.

Intraindividual association of PTSD symptoms with binge drinking among trauma-exposed students

People, particularly undergraduate students, who report elevated symptoms of posttraumatic stress disorder (PTSD) are at elevated risk of binge drinking. The present study used ecological momentary assessment to (a) evaluate whether PTSD severity, specifically, or psychological distress, generally, are associated with binge drinking and (b) examine the self-medication and susceptibility models of the comorbidity of PTSD with binge drinking while accounting for shared liability (i.e., the between-person association of PTSD symptom severity with binge drinking). Within a larger study of undergraduate student mental health, for 14 days, students who reported a potentially traumatic experience (N = 276) reported nightly on use of alcohol and psychoactive substances and thrice daily on current affect, internalizing symptoms, and PTSD symptoms. Daily binge drinking, per the NIAAA definition, was analyzed using multivariate mixed effects, multilevel logistic regression. Results support the self-medication model; participants were more likely to binge drink on days marked by elevated PTSD symptoms, OR = 2.82, p < .01. Binge drinking was also more likely on weekends, OR = 4.21, p < .0001, and days marked by elevated daily positive affect, OR = 1.60, p < .001. Binge drinking was not associated with concurrent depressive or general anxiety symptoms (p > .30). PTSD symptoms were not associated with use of cannabis or other substances (p > .06). Regarding the susceptibility model, following a binge drinking episode, participants reported elevated depressive symptoms, B = 0.34, p = .04, but no change in affect, PTSD symptoms, or general anxiety symptoms (p > .16). Results suggest that, beyond understanding who is at risk for binge drinking, fluctuations in PTSD severity clarify when students engage in binge drinking. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes

OBJECTIVE

Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control.

METHODS

One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics.

RESULTS

Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups.

CONCLUSIONS

Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.

Job Tension Growth and Emotional Intelligence in Challenge-Based Learning

This paper presents a study that aims to identify the trajectory of job tension during a challenge-based learning (CBL) activity and study the role of student workgroup emotional intelligence in such a context. More longitudinal research on student stress is deemed necessary. The authors used Karasek's demand-control model (1979), collected longitudinal data (gathered at ten time points) from a 73-member team participating in an international student competition, and analyzed the data using the latent growth model approach. To the authors' knowledge no research has used panel data with multiple time points to explore the trajectory of job tension during a challenge-based learning activity. The findings indicate that the job tension of teams participating in a challenge-based learning activity has a quadratic rate of change, and that student work group emotional intelligence predicts individual differences with respect to team-level job tension. Practical implications include actions to improve the implementation of CBL tasks and to better deal with job tension and emotional intelligence in working groups.

Strategies for the Planning and Handling of Missing Data in Nursing Research

BACKGROUND

Missing data are an inevitable reality in research. Nurse educators can promote proactive thinking about this topic to help avoid excessive missingness. The purpose of this article is to encourage nurses to view missing data as an accepted reality and to consider strategies for anticipating and minimizing missing data throughout the research process.

METHOD

The common causes of missing data and ways to minimize their occurrence are discussed, along with suggestions for adopting a statistical mindset about missing data. Rubin's framework for missingness as a random process, modern statistical methods for analyzing missing data, and recommendations for reporting also are discussed.

CONCLUSION

Nurse educators and researchers should understand all aspects of missing data, including the types, occurrence, causes, potential problems, and strategies for preventing, handling, and reporting missing data. By doing so, the occurrence of missing data can be lessened, thereby minimizing various problems that can result. [J Nurs Educ. 2020;59(5):249-255.].

Prospective Associations between Sport Participation and Indices of Mental Health across Adolescence

Youth sport offers physical and psychosocial components that may be beneficial for adolescents' mental health, but the prospective directionality between sport participation and mental health has not been clearly established. The current study examined longitudinal associations between sport participation (individual and team sport) and mental health indices (depressive symptoms, anxiety symptoms, emotional symptoms, hyperactivity symptoms, conduct problems, peer problems, and prosocial behavior) across adolescence (ages 12-17) in a nationally representative Australian sample of 3956 participants at T1 (M_age = 12.41 years, SD = 0.49; 49% female), 3537 at T2 (M_age = 14.41 years, SD = 0.49; 49% female), and 3089 at T3 (M_age = 16.46 years, SD = 0.51; 49% female). Using random intercept cross-lagged panel modeling, several significant within-person effects were found. Notably, greater participation in team sport prospectively predicted fewer symptoms of depression and anxiety at subsequent timepoints. This study increases the understanding of how sport participation may relate to mental health among adolescents and provides critical evidence to inform policy.

Differences and Similarities in Predictors of Expressive Vocabulary Development between Children with Down Syndrome and Young Typically Developing Children

The purpose of this study was to examine potential differences in the predictors of expressive vocabulary development between children with Down syndrome and typically developing children to support preparation for intervention development. An age cohort of 43 children with Down syndrome and 57 typically developing children with similar nonverbal mental age levels were assessed at three time points. Linear mixed models were used to investigate the predictors of expressive vocabulary over time. Both groups achieved progress in expressive vocabulary. The typically developing children had steeper growth than the children with Down syndrome (1.38 SD vs. 0.8 SD, p < 0.001). In both groups, receptive vocabulary, auditory memory, and the home literacy environment were significant predictors of development. In the children with Down syndrome, the phonological awareness and oral motor skills were also significant. Group comparisons showed that receptive vocabulary, auditory memory and oral motor skills were stronger predictors in the children with Down syndrome than in the typically developing children. These results indicate that children with Down syndrome are more vulnerable when it comes to risk factors that are known to influence expressive vocabulary than typically developing children. Children with Down syndrome therefore require early broad-based expressive vocabulary interventions.

Depressive Symptoms Moderate Dating Violence Prevention Outcomes Among Adolescent Girls

Purpose: Few dating violence prevention programs assess how variations in initial violence risk affects responsiveness. This study examines the efficacy of Date SMART, a dating violence and sexual risk prevention program designed to target high-risk adolescent girls, in preventing dating violence in the context of varying initial levels of depressive symptoms. Method: A diverse sample of N = 109 female adolescents with a history of physical dating violence participated in a randomized controlled trial of the Date SMART program and a knowledge only (KO) comparison. Results: Using baseline depression level as a primary risk factor, a series of multilevel models revealed significant main effects of baseline depression such that higher baseline depression was associated with greater physical dating violence perpetration and victimization. Results also showed a three-way interaction for assessment point, depressive symptoms, and condition for physical dating violence perpetration. Specifically, those with higher baseline depression in Date SMART showed significantly less physical dating violence perpetration at follow-ups compared with those with higher baseline depression in the KO group. This difference in violence reduction between conditions was not observed for those with lower baseline depression. Discussion: Date SMART appears to effectively reduce physical dating violence perpetration in those with higher levels of initial risk. Current findings support that adolescents with different risk profiles respond differently to violence prevention programs.

Understanding Variation in Longitudinal Data Using Latent Growth Mixture Modeling

OBJECTIVE

This article guides researchers through the process of specifying, troubleshooting, evaluating, and interpreting latent growth mixture models.

METHODS

Latent growth mixture models are conducted with small example dataset of N = 117 pediatric patients using Mplus software.

RESULTS

The example and data show how to select a solution, here a 3-class solution. We also present information on two methods for incorporating covariates into these models.

CONCLUSIONS

Many studies in pediatric psychology seek to understand how an outcome changes over time. Mixed models or latent growth models estimate a single average trajectory estimate and an overall estimate of the individual variability, but this may mask other patterns of change shared by some participants. Unexplored variation in longitudinal data means that researchers can miss critical information about the trajectories of subgroups of individuals that could have important clinical implications about how one assess, treats, and manages subsets of individuals. Latent growth mixture modeling is a method for uncovering subgroups (or "classes") of individuals with shared trajectories that differ from the average trajectory.

Body Mass Index Trajectories in the First 5 Years and Associated Antenatal Factors

Background: The increasing prevalence of childhood obesity is an important public health issue and the development of obesity in early life and associated risk factors need to be better understood. The aim of this study was to identify distinct body mass index trajectories in the first 5 years of life and to examine their associations with factors identified in pregnancy, including metabolic parameters. Methods: BMI measurements from 2,172 children in Ireland enrolled in the BASELINE cohort study with BMI assessments at birth, 2, 6, and 12 months, and 2 and 5 years were analyzed. Growth mixture modeling was used to identify distinct BMI trajectories, and multivariate multinomial logistic regression was used to assess the association between these trajectories and antenatal factors. Results: Three distinct BMI trajectories were identified: normal (89.6%); rapid gain in the first 6 months (7.8%); and rapid BMI after 12 months (2.6%). Male sex and higher maternal age increased the likelihood of belonging to the rapid gain in the first 6 months trajectory. Raised maternal BMI at 15 weeks of pregnancy and lower cord blood IGF-2 were associated with rapid gain after 1 year. Conclusion: Sex, maternal age and BMI, and IGF-2 levels were found to be associated with BMI trajectories in early childhood departing from normal growth. Further research and extended follow-up to examine the effects of childhood growth patterns are required to understand their relationship with health outcomes.

The Differential Impact of Retirement on Informal Caregiving, Volunteering, and Grandparenting: Results of a 3-Year Panel Study

Objectives

Research on retirees’ engagement in informal caregiving, formal volunteering, and grandparenting often views retirement as a permanent exit from the workforce. Retirement processes are, however, increasingly diverse: some retire fully while others remain in paid work after retirement from a career job. A relevant but understudied question is how these different retirement processes relate to changes in engagement in unpaid productive activities. Building on role theory, we hypothesize that full and working retirees face different consequences of retirement and, therefore, differ in engagement in unpaid productive activities.

Method

We analyze data that were collected in 2015 and 2018 among 4,882 Dutch individuals aged 60–65 and employed at baseline. Around half had fully retired at follow-up and 10% worked after their retirement. At follow-up, more respondents are regularly volunteering (from 17% to 27%) and grandparenting (from 39% to 53%) than at baseline, while caregiving remains rather stable (from 33% to 30%).

Results

Conditional change models show that full retirement is associated with an increased likelihood of volunteering and grandparenting, but not caregiving. Engagement in postretirement work is related to an increased likelihood of looking after the grandchildren, but not to volunteering or providing informal care.

Discussion

Our findings suggest that volunteering is important for replacing weak ties after full retirement, while grandparenting might be a new, central role in retirement—irrespective of work engagement. Retirees seem to engage in unpaid productive activities for different reasons.

Mental Health Trajectories of Fathers Following Very Preterm Birth: Associations With Parenting

OBJECTIVE

Mothers of infants born very preterm (VPT) are at high risk of mental health difficulties. However, less is known about the course of fathers' depressive and anxiety symptoms over time, and the implications this may have for early parenting behaviors.

METHODS

In total, 100 fathers of 125 infants born VPT (<30 weeks' gestation) completed questionnaires assessing depressive and anxiety symptoms shortly after their infant's birth, and when their infant reached term-equivalent age, 3 months, 6 months, and 12 months' corrected age. At 12 months' corrected age, fathers' parenting behaviors were assessed using the Emotional Availability Scales. Longitudinal latent class analysis was used to identify trajectories of fathers' depressive and anxiety symptoms, and linear regression equations examined relationships between these trajectories and fathers' parenting behaviors.

RESULTS

For both depressive and anxiety symptoms, two distinct trajectories were identified. For depression, most fathers were assigned to the persistently low symptom trajectory (82%), while the remainder were assigned to the persistently high symptom trajectory (18%). For anxiety, 49% of fathers were assigned to the persistently low symptom trajectory, while 51% were assigned to the trajectory characterized by moderate symptoms over the first postnatal year. There were no significant differences in parenting behaviors between fathers assigned to the different depressive and anxiety symptom trajectories.

CONCLUSIONS

Fathers of infants born VPT are at risk of chronic depressive and anxiety symptoms over the first postnatal year, highlighting the need for screening and ongoing support.

Linking Maternal Depression to Adolescent Internalizing Symptoms: Transmission of Cognitive Vulnerabilities

The mechanisms of the well-documented relationship between maternal depression and offspring psychopathology are not yet fully understood. Building upon cognitive theories of depression and the modeling hypothesis, path analyses tested whether maternal depression history predicted adolescent internalizing symptoms via the transmission of cognitive vulnerabilities within a sample of 635 adolescents (Mage = 13.1 years, range = 11.2-17.2 years; 53% female; 48% African American/Black) and their primary female caregivers. Maternal depression history did not directly predict adolescent symptoms. Two significant indirect effects were found; maternal depression history was associated with maternal negative cognitive style, which predicted greater adolescent negative generalization, which, in turn, predicted adolescents' greater depressive and anxiety symptoms. These findings suggest that the transmission of cognitive vulnerabilities may link maternal depression and offspring internalizing psychopathology.

Usefulness of Linear Mixed-Effects Models to Assess the Relationship between Objective and Subjective Internal Load in Team Sports

Internal load can be objectively measured by heart rate-based models, such as Edwards' summated heart rate zones, or subjectively by session rating of perceived exertion. The relationship between internal loads assessed via heart rate-based models and session rating of perceived exertion is usually studied through simple correlations, although the Linear Mixed Model could represent a more appropriate statistical procedure to deal with intrasubject variability. This study aimed to compare conventional correlations and the Linear Mixed Model to assess the relationships between objective and subjective measures of internal load in team sports. Thirteen male youth beach handball players (15.9 ± 0.3 years) were monitored (14 training sessions; 7 official matches). Correlation coefficients were used to correlate the objective and subjective internal load. The Linear Mixed Model was used to model the relationship between objective and subjective measures of internal load data by considering each player individual response as random effect. Random intercepts were used and then random slopes were added. The likelihood-ratio test was used to compare statistical models. The correlation coefficient for the overall relationship between the objective and subjective internal data was very large (r = 0.74; ρ = 0.78). The Linear Mixed Model using both random slopes and random intercepts better explained (p < 0.001) the relationship between internal load measures. Researchers are encouraged to apply the Linear Mixed Models rather than correlation to analyze internal load relationships in team sports since it allows for the consideration of the individuality of players.

Emotional and interpersonal mechanisms in community SSRI treatment of social anxiety disorder

BACKGROUND

Affective and interpersonal behavioural patterns characteristic of social anxiety disorder show improvement during treatment with serotonin agonists (e.g., selective serotonin reuptake inhibitors), commonly used in the treatment of social anxiety disorder. The present study sought to establish whether, during community psychopharmacological treatment of social anxiety disorder, changes in positive or negative affect and agreeable or quarrelsome behaviour mediate improvement in social anxiety symptom severity or follow from it.

METHODS

Adults diagnosed with social anxiety disorder (n = 48) recorded their interpersonal behaviour and affect naturalistically in an event-contingent recording procedure for 1-week periods before and during the first 4 months of treatment with paroxetine. Participants and treating psychiatrists assessed the severity of social anxiety symptoms monthly. A multivariate latent change score framework examined temporally lagged associations of change in affect and interpersonal behaviour with change in social anxiety symptom severity.

RESULTS

Elevated agreeable behaviour and positive affect predicted greater subsequent reduction in social anxiety symptom severity over the following month of treatment. Elevated negative affect, but not quarrelsome behaviour, predicted less subsequent reduction in symptom severity.

LIMITATIONS

Limitations included limited assessment of extreme behaviour (e.g., violence) that may have precluded examining the efficacy of paroxetine because of the lack of a placebo control group.

CONCLUSION

The present study suggests that interpersonal behaviour and affect may be putative mechanisms of action for serotonergic treatment of social anxiety disorder. Prosocial behaviour and positive affect increase during serotonergic treatment of social anxiety disorder. Specifically, modulating agreeable behaviour, positive affect and negative affect in individuals' daily lives may partially explain and refine clinical intervention.

An Interdisciplinary Examination of Stress and Injury Occurrence in Athletes

This paper adopts a novel, interdisciplinary approach to explore the relationship between stress-related psychosocial factors, physiological markers and occurrence of injury in athletes using a repeated measures prospective design. At four data collection time-points, across 1-year of a total 2-year data collection period, athletes completed measures of major life events, the reinforcement sensitivity theory personality questionnaire, muscle stiffness, heart rate variability and postural stability, and reported any injuries they had sustained since the last data collection. Two Bayesian networks were used to examine the relationships between variables and model the changes between data collection points in the study. Findings revealed muscle stiffness to have the strongest relationship with injury occurrence, with high levels of stiffness increasing the probability of sustaining an injury. Negative life events did not increase the probability of injury occurrence at any single time-point; however, when examining changes between time points, increases in negative life events did increase the probability of injury. In addition, the combination of increases in negative life events and muscle stiffness resulted in the greatest probability of sustaining an injury. Findings demonstrated the importance of both an interdisciplinary approach and a repeated measures design to furthering our understanding of the relationship between stress-related markers and injury occurrence.

Transdiagnostic Internet-delivered cognitive behaviour therapy with therapist support offered once-weekly or once-weekly supplemented with therapist support within one-business-day: Pragmatic randomized controlled trial

In routine care, internet-delivered cognitive behaviour therapy (iCBT) regularly includes therapist support delivered via secure email, but the optimal response time to emails is unknown. In this study, we compared the benefits of therapists providing support once-weekly versus therapists providing support once-weekly supplemented with a one-business-day response to all patient emails. This pragmatic randomized controlled trial included therapists employed by a specialized iCBT clinic or community mental health clinics, where providing iCBT is a secondary service. Patients with depression and/or anxiety who enrolled in transdiagnostic iCBT (5 core lessons over 8 weeks) were randomized to: 1) once-weekly support supplemented with a one-business-day response to patient emails by specialized therapists (n = 233); 2) once-weekly support also offered by specialized therapists (n = 216); or 3) once-weekly support offered by community clinic therapists (n = 226). Outcomes were measured at 8, 12, 24, and 52-weeks post-enrollment. Patient engagement and treatment experiences (e.g., treatment satisfaction, therapist alliance) were also assessed and a focus group was conducted with therapists. Supplementing once-weekly therapist support with a one-business-day response to patient emails resulted in therapists sending more emails to patients (M: 13 versus 9) and required more therapist time over treatment (M: 155 versus 109 min), but was not associated with improved outcomes, patient engagement or treatment experiences. All groups showed large improvements in symptoms of depression and anxiety maintained at 52-week follow-up, strong engagement and positive treatment experiences. Therapists viewed challenges of responding to patient emails within one-business-day to outweigh benefits. Contrary to expectations, supplementing once-weekly therapist support with a one-business-day response to all patient emails did not benefit patients and increased therapist time as well as therapist challenges when delivering iCBT in routine care.

Establishing the Minimal Clinically Important Difference for the Hospital Anxiety and Depression Scale in Patients With Cardiovascular Disease

PURPOSE

The Hospital Anxiety and Depression Scale (HADS) is frequently used by clinicians to assess anxiety and depression in patients with cardiovascular disease; yet, its minimal clinically important difference (MCID) has not been established. The purpose of this study was to establish an MCID for the HADS in patients with cardiovascular disease.

METHODS

A sample of 591 patients (74% male; ethnicity = 89% white; mean ± standard deviation [SD]: age = 63 ± 10 yr; and body mass index = 29.1 ± 5.6 kg/m) with cardiovascular disease enrolled in a 3-mo cardiac rehabilitation program were included in this study. The MCID for the HADS was estimated using distribution-based methods (ie, standard deviation, effect size, standard error of measurement, and minimal detectable change), anchor-based methods (ie, health transition question, correlation and linear regression, and receiver operating characteristic curve), and Delphi methodology (ie, clinical consensus).

RESULTS

A total of 18 MCID values were calculated ranging from 0.81 to 5.21 (Anxiety subscale) and 0.5 to 5.57 (Depression subscale). The final MCID for the HADS, triangulated from the distribution-based, anchor-based, and Delphi-based findings, was 1.7 points.

CONCLUSIONS

Our work provides the first estimates of an MCID by triangulating multiple methodologies for the HADS in patients with cardiovascular disease. This MCID may serve as an indicator of treatment success for clinicians and researchers and guide future interventions to improve the mental health of patients with cardiovascular disease.