The longitudinal association between external locus of control, social cognition and adolescent psychopathology

Locus of Control as a Mediator of the Relationships Between Motivational Systems and Trait Anxiety

The Reinforcement Sensitivity Theory, first proposed by Gray and later revised, describes three motivational systems: Behavioral Inhibition System (BIS), Behavioral Activation System (BAS), and Fight-Flight-Freeze System (FFFS). Studies have shown that high BIS and FFFS activation are positively related to anxiety symptoms, yet the relationship between BAS and anxiety remains unclear. Research data have also suggested that anxiety symptoms occur with the loss of perceived control. Thus, although studies on the direct effect of locus of control (LOC) on trait anxiety have accumulated for many years, the issue of how LOC may mediate the relationship between BIS/BAS/FFFS sensitivity and anxiety has not been addressed. This study aimed to explore the mediating role of LOC orientation on trait anxiety among young adults in association with these three motivational systems. Cross-sectional data were obtained from 422 volunteers. The BIS/BAS Scale, Trait Anxiety Inventory, and Rotter's Internal-External LOC Scale were applied. A series of mediation analyses were performed to estimate total, indirect, and direct effects. The results showed that BIS and FFFS positively predicted trait anxiety. In addition, LOC positively predicted trait anxiety and BIS. The results of the mediation analyses indicated that LOC functioned as a partial mediator between BIS and trait anxiety. This finding revealed that a high BIS level, one of the motivational systems, was associated with external LOC, which in turn contributed to reporting high trait anxiety in young adults. Hence, BIS and external LOC orientation could be suggested as risk factors for trait anxiety. As the external LOC orientation of individuals with high punishment sensitivity increased, their trait anxiety levels also increased. Therefore, it was suggested that it might be useful to be aware that LOC orientations of individuals with BIS sensitivity may pose a risk for trait anxiety.

The role of social cognitions in the social gradient in adolescent mental health: A longitudinal mediation model

The social gradient in adolescent mental health is well established: adolescents' socioeconomic status is negatively associated with their mental health. However, despite changes in social cognition during adolescence, little is known about whether social cognitions mediate this gradient. Therefore, this study tested this proposed mediational path using three data waves, each 6 months apart, from a socioeconomically diverse sample of 1,429 adolescents (Mage = 17.9) in the Netherlands. Longitudinal modeling examined whether three social cognitions (self-esteem, sense of control, and optimism) mediated associations between perceived family wealth and four indicators of adolescent mental health problems (emotional symptoms, conduct problems, hyperactivity, and peer problems). There was evidence of a social gradient: adolescents with lower perceived family wealth reported more concurrent emotional symptoms and peer problems and an increase in peer problems 6 months later. Results also showed evidence of mediation through social cognitions, specifically sense of control: adolescents with lower perceived family wealth reported a decrease in sense of control (though not self-esteem nor optimism) 6 months later, and lower sense of control predicted increases in emotional symptoms and hyperactivity 6 months later. We found concurrent positive associations between perceived family wealth and all three social cognitions, and concurrent negative associations between social cognitions and mental health problems. The findings indicate that social cognitions, especially sense of control, may be an overlooked mediator of the social gradient in adolescent mental health.

The beneficial role of personality in preserving well-being during the pandemic: A longitudinal population study

BACKGROUND

The COVID-19 pandemic resulted in increased rates of mental health problems. We examined the possible role of the personality characteristic, Locus of Control (LOC), in moderating pandemic-induced stress.

METHODS

The UK-based Avon Longitudinal Study of Parents & Children (ALSPAC), 7021 adults (mean ages: women 57.6 (SD = 4.48); partners 60.5 (SD = 5.36)) responded to a 2020 questionnaire which included a generalised measure of LOC. Between March 2020-January 2021, questionnaires focussed on the pandemic were administered, which included measures of mental health. Over 60 % of respondents completed questionnaires at three timepoints of interest.

RESULTS

In those with an internal LOC higher rates of positive well-being and reduced likelihood of anxiety and depression were shown compared to those who were external, e.g. after adjustment for socioeconomic/demographic factors mean differences in well-being score for internal compared with external women was +2.01 (95%CI +1.02,+2.10) p = 0.0001; for their partners +2.52 (95%CI +1.22,+3.82) p = 0.0002. External women were more likely than internals to have depression (adjusted OR 3.41 [95%CI 1.77,6.57] p < 0.0005.

LIMITATIONS

Attrition is a problem in this 30-year-old longitudinal cohort. Those still participating are more likely to have higher education and SES levels, be female and have an internal LOC. This population suffers from a lack of ethnic diversity.

CONCLUSIONS

Having an internal LOC positively moderated the effects of pandemic-induced stress on the frequency of anxiety and depression in middle-age. Programmes geared to raise internality and coping strategies may have long-term benefits on well-being in stressful situations, especially for women and frontline health professionals.

Siblings of young people with chronic illness: Caring responsibilities and psychosocial functioning

Siblings of young people with chronic illness commonly undertake caring responsibilities for their affected brother/sister, which may encourage maturation, yet may also be perceived as a burden. Our study determined (1) siblings' caring responsibilities, (2) siblings' current emotional distress and psychosocial functioning, and (3) how siblings' caring responsibilities and psychosocial functioning related to familial relationships and coping strategies. Siblings completed questionnaires which contained Sibling Inventory of Behavior, Sibling Inventory of Differential Experiences, PedsQL, emotion thermometers, Brief COPE, and a checklist of caregiving responsibilities. We analyzed the data with t-tests and multi-level models. Forty-five siblings (mean age = 15.40 years, SD = 3.31 years; 60.0% female) participated. Siblings who had caring responsibilities (n = 26, 57.8%) reported lower anxiety symptoms, lower need for help, greater use of problem-focused coping, and more companionship and teaching/directiveness with their affected brother/sister than siblings without caring responsibilities. Siblings reported lower psychosocial and physical functioning when they perceived their parents provided them with less affection than their affected brother/sister. Family-based psychosocial interventions may aim to improve the sibling-parent relationship (including expressing affection) and the sibling-sibling relationship. Future interventions may also focus on increasing siblings' use of problem-focused coping strategies.

The role of inflammatory markers and cortisol in the association between early social cognition abilities and later internalising or externalising problems: Evidence from a UK birth cohort

OBJECTIVE

Deficits in social cognition are associated with internalising (emotional and peer problems) and externalising (conduct problems and hyperactivity/inattention) symptoms in youth. It has been suggested that stress may be one of the mechanisms underlying these associations. However, no empirical studies have investigated if physiological stress can explain the prospective associations between social cognition deficits and internalising and externalising symptoms in the general youth population. This study addressed this question and focused on two indicators of physiological stress, dysregulated diurnal cortisol patterns and systemic inflammation.

METHOD

Participants were 714 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. Bayesian structural equation modelling was used to investigate a) the associations of social cognition abilities at ages 8, 11, and 14 years with internalising and externalising problems at age 17 years and b) the potential mediating effects of cortisol parameters at age 15 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at ages 9 and 16 years.

RESULTS

We found that social cognition difficulties were associated with later internalising and externalising problems. Flattened diurnal cortisol slope was associated with hyperactivity/inattention problems two years later. Lower morning cortisol partially mediated the direct association between social communication deficits at 8 years and hyperactivity/inattention and conduct problems at 17 years, even after adjustments for inflammation and confounders (for hyperactivity/inattention: indirect effect = 0.07, 95% CI [0.00, 0.18], p = .042; for conduct problems: indirect effect = 0.04, 95% CI [0.00, 0.11], p = .040). We did not find a significant association between systemic inflammation and social cognition difficulties, internalising problems, or externalising problems.

CONCLUSION

Our findings suggest that part of the effect of social communication difficulties in childhood on externalising problems in adolescence was mediated by lower morning cortisol. Hence, our study indicates that the hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis may be one of the physiological mechanisms linking some social cognition deficits to externalising problems.

Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions

Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.

Perceived discrimination and relative deprivation in Chinese migrant adolescents: the mediating effect of locus of control and moderating effect of duration since migration

BACKGROUND

Associations between perceived discrimination and relative deprivation have been observed among both general and migrant populations. However, it is unclear how, and under what conditions, perceived discrimination relates to relative deprivation, a subjective cognition and affective experience in which individuals or groups perceive themselves as disadvantaged, compared to their peers. Therefore, this study aimed to construct a moderated mediation model to examine the roles of locus of control and duration since migration in the relationship between perceived discrimination and relative deprivation among Chinese rural-to-urban migrant adolescents.

METHODS

We conducted a cross-sectional study using a convenience sampling method in three coastal cities in southeast China. We recruited 625 Chinese rural-to-urban migrant adolescents, who completed a battery of questionnaires assessing perceived discrimination, relative deprivation, locus of control, and demographic variables. Regression-based statistical mediation and moderation were conducted using the PROCESS macro for SPSS.

RESULTS

After controlling for sex and age, perceived discrimination was positively associated with migrant adolescents' relative deprivation, and external locus of control partially mediated this connection. Furthermore, the mediating effect was moderated by the duration of the migration. In relatively recently migrated adolescents, perceived discrimination was significantly related to relative deprivation through a greater external locus of control; however, this indirect association was not significant for adolescents with long-term migratory duration.

CONCLUSION

The results of our analysis expand our understanding of the link between perceived discrimination and relative deprivation. Moreover, these findings may provide practical guidance for interventions among Chinese rural-to-urban migrant adolescents to raise their social status and improve their mental health by addressing the macro-social psychological causes of relative deprivation.

The link between social communication and mental health from childhood to young adulthood: A systematic review

This systematic review investigates the current state of the literature on the association between social communication (SC) skills and mental health outcomes in children and young adults. We ran searches using terms describing SC and mental health in the following databases: PubMed, the Psychology and Behavioral Sciences Collection, APA PsychInfo, the Education Resource Information Center (ERIC) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We included studies that both measured SC before age 21 years and assessed a mental health component, such as behavior/conduct problems, anxiety, depression, or emotional problems, before age 30. Only peer-reviewed articles published in or after 2000 were retained. In total, 27 studies were included in the narrative synthesis. Overall, the methodological quality was good. A longitudinal design was used in 12 studies, seven of which sourced data from the Avon Longitudinal Study of Parents and Children. Most studies investigated the broad concept of pragmatic language and its influence on internalizing, externalizing, and peer-relationship problems. The analyzed publications included population-based studies and studies investigating special populations with existing mental health problems or at increased risk of developing them. The population-based cross-sectional studies showed significantly higher rates of SC problems in children with mental health problems while those with a longitudinal design found earlier onset and more persistent mental health problems in children who had the most severe SC difficulties. Studies with special populations confirmed more SC problems as compared to typically developing children and worse mental health outcomes in children with additional SC difficulties. The available literature thus shows consistently significant, mostly moderate associations between SC skills and mental health outcomes. SC difficulties earlier in life can predict mental health problems and impact their trajectories.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286598], identifier [CRD42022286598].

Transactional processes between childhood maltreatment and depressive symptoms from middle childhood to early adolescence: Locus of control as a mediator

BACKGROUND

Previous research has identified a significant, positive relation between childhood maltreatment and depressive symptoms. However, the findings required replication at the within-person level. Moreover, the mediating mechanism of locus of control accounting for their relations has yet to be fully evaluated. Thus, this study examined the dynamic longitudinal relations between childhood maltreatment and depressive symptoms including whether locus of control functioned as a mediator between them after separating between-person effects from within-person effects.

METHODS

A sample of 4110 Chinese children (50.60% boys; M_age = 9.89 at Wave 1) covering the transitional period from middle childhood to early adolescence completed a package of self-report measures on 5 occasions across 2.5 years, using 6-month intervals. Random Intercept Cross-Lagged Panel Models were applied to disaggregate between- and within-person effects. Also, alternative Cross-Lagged Panel Models were applied.

RESULTS

Locus of control played a mediating role in the reciprocal relations between childhood maltreatment and depressive symptoms at the within-person level.

LIMITATIONS

Some limitations existed in the measures. Moreover, sexual abuse was not investigated in this study.

CONCLUSIONS

The findings highlighted the mediating role of locus of control in the reciprocal relations between childhood maltreatment and depressive symptoms at the within-person level, suggesting that interventions targeted at promoting internal locus of control may help prevent the developmental pathway from childhood maltreatment to depressive symptoms and vice versa from middle childhood to early adolescence.

Social cognition and self-reported ASD traits in young adults who have reported psychotic experiences: A population-based, longitudinal study

OBJECTIVE

Social cognition is considered a trait marker of psychosis, and has rarely been investigated in young adults who have reported psychotic experiences (PE). The aim of the present study was to explore whether social cognition, self-reported Autism Spectrum Disorder (ASD) traits and functioning were associated with PE.

METHODS

Participants were invited to take part in a 10-year follow-up study (mean age 20.9 years), of whom 103 participants returned, including 41 who had reported PE either past or current. Social cognition (theory of mind, social perception and locus of control) was assessed and a self-report measure of ASD traits was administered. Psychopathology and global functioning were assessed using the SCID-5. Analyses investigated group differences between PE and controls, and the association between social cognition and functioning in the PE group. A mediation analysis investigated if the association between PE and social cognition was explained by ASD traits.

RESULTS

The PE group had poorer theory of mind scores (F = 4.22, p = .043), specifically for neutral and negative stimuli, and an external locus of control (F = 5.73, p = .019) in young adulthood. The PE group had a significantly greater number of self-reported ASD traits than the controls (χ²(2) = 10.65). External locus of control had a significant negative correlation with current role functioning in the PE group. The association between PE and social cognition abilities was not mediated by ASD traits.

CONCLUSION

Psychotic experiences are associated with poorer theory of mind and an external locus of control, as well as proportionally more self-reported ASD traits, in young adulthood.

Adolescents' Understanding of What Causes Emotional Distress: A Qualitative Exploration in a Non-clinical Sample Using Ideal-Type Analysis

Background: There is increased interest in early intervention and prevention of mental health difficulties during adolescence; thus, we are seeing increased efforts to optimize well-being during this epoch. Positive emotional experiences are a central component of overall well-being. However, research exploring what adolescents perceive to be the cause(s) of their emotional difficulties is lacking. Improving understanding of this issue within non-clinical adolescent groups may provide useful insight into how to develop strategies to support young people as they navigate emotional difficulties.

Objectives: The aim of this research was to explore if meaningful categories of perceived cause(s) for emotional distress exist for non-clinical adolescent groups.

Methods: The data for this study were drawn from interviews across 6 sites in England conducted as part of the 5-year national evaluation of the HeadStart Learning Programme. The sample comprised of 32 young people aged 11–12 years from the first annual wave of qualitative data collection in 2017. Ideal type analysis—a qualitative form of person-centered analysis—was used to construct a typology of adolescents perceived cause(s) for emotional distress.

Findings: We identified five distinct categories of perceived cause: (1) perceived lack of control; (2) unfair treatment; (3) others, their actions and judgements as the catalyst; (4) concerns for self and others; and, (5) self as cause.

Conclusions: Our findings illustrate that distinct categories for perceived cause of emotional distress exist among adolescents considered to be “at risk” of developing mental health difficulties, which provides a foundation for future necessary work seeking to investigate the possible link between perceived cause for emotional distress and help-seeking behavior among sub-clinical groups.

Problematic Internet use among residential college students during the COVID-19 lockdown: A social network analysis approach

BACKGROUND AND AIMS

During the COVID-19 lockdown, problematic Internet use (PIU) has become a serious issue among residential college students, who remain physically isolated from off-campus society. This study constructs an integrated model to investigate the influencing mechanisms of internal locus of control (LOC) and objective peer effects.

METHODS

Residential college students (n = 494) were surveyed from a single department of a Chinese university. An item from the World Value Survey was employed to measure internal LOC, while objective peer effects were assessed via friends' mutual nominations. Finally, PIU was measured using Young's Internet Addiction Tests, while a social network analysis and logit regression were combined to estimate various factors' effects on PIU.

RESULTS

In our sample, the prevalence rate of PIU was 30.6%, and while internal LOC was a protective factor for PIU, its protective role was diluted when exposed to a peer environment with high PIU prevalence. Furthermore, indegree performed contrasting roles on PIU under various network conditions. It acted as a protective factor when exposed to a low prevalence of PIU in a peer environment; however, it became a risk factor when PIU peers were prevalent. Lastly, the protective efficacy of betweenness was activated when individuals had more than one PIU friend.

DISCUSSION AND CONCLUSIONS

Further intervention studies focusing on individuals with a weak internal LOC are recommended during the lockdown. Additionally, interventions that consider the network structures carefully, may enhance the prevention of PIU.

The Association Between Locus of Control and Psychopathology: A Cross-Cohort Comparison Between a UK (Avon Longitudinal Study of Parents and Children) and a Japanese (Tokyo Teen Cohort) Cohort

Background: An external locus of control (externality) is associated with poorer psychopathology in individualist cultures, but associations are reported to be weaker in collectivist cultures where an external style is less maladaptive. We investigated the prospective association between externality and psychotic-like experiences (PLE) and depressive symptoms (DS) and compared the strength of associations between a UK and a Japanese cohort. Method: Cross-cultural cohort study of a UK (Avon Longitudinal Study of Parents and Children) and a Japanese cohort (Tokyo Teen Cohort). Externality was assessed using the Children's Nowicki and Strickland Internal, External Scale and DS using the Short Moods and Feelings Questionnaire in both cohorts, PLE were assessed with the Psychosis-Like Experiences Questionnaire (ALSPAC), and the Adolescent Psychotic-Like Symptom Screener (TTC). Associations were investigated using multivariable regression models and bivariate regression models to compare the strength of associations. Results: Mean externality in both childhood and adolescence was higher in ALSPAC than in the TTC. Childhood externality was associated with PLE in late childhood and adolescence in both cohorts and adolescent externality was associated with PLE in young adulthood in the ALSPAC cohort. There was a more mixed pattern of association between externality and DS scores. There was little evidence of any differences in the strength of associations between externality and different psychopathologies, or between cohorts. In ALSPAC adolescent externality and early adult psychopathology were more strongly associated than childhood externality and adolescent and early adult psychopathology. There was no evidence that change in externality between childhood and adolescence was associated with new onset PLE or DS in early adulthood. Conclusion: An external locus of control is associated with poor mental health regardless of cultural context.

Locus of Control and Negative Cognitive Styles in Adolescence as Risk Factors for Depression Onset in Young Adulthood: Findings From a Prospective Birth Cohort Study

Whilst previous observational studies have linked negative thought processes such as an external locus of control and holding negative cognitive styles with depression, the directionality of these associations and the potential role that these factors play in the transition to adulthood and parenthood has not yet been investigated. This study examined the association between locus of control and negative cognitive styles in adolescence and probable depression in young adulthood and whether parenthood moderated these associations. Using a UK prospective population-based birth cohort study: the Avon Longitudinal Study of Parents and Children (ALSPAC), we examined the association between external locus of control and negative cognitive styles in adolescence with odds of depression in 4,301 young adults using logistic regression models unadjusted and adjusted for potential confounding factors. Interaction terms were employed to examine whether parenthood (i.e., having become a parent or not) moderated these associations. Over 20% of young adults in our sample were at or above the clinical threshold indicating probable depression. For each standard deviation (SD) increase in external locus of control in adolescence, there was a 19% (95% CI: 8-32%) higher odds of having probable depression in young adulthood, after adjusting for various confounding factors including baseline mood and different demographic and life events variables. Similarly, for each SD increase in negative cognitive styles in adolescence, there was a 29% (95% CI: 16-44%) higher odds of having probable depression in the adjusted model. We found little evidence that parenthood status moderated the relationship between external locus of control or negative cognitive styles in adolescence and probable depression following adjustment for confounding factors. Effect estimates were comparable when performed in the complete case dataset. These findings suggest that having an external locus of control and holding negative cognitive styles in mid- to late adolescence is associated with an increased likelihood of probable depression in young adulthood.

Childhood trauma and cognitive biases associated with psychosis: A systematic review and meta-analysis

Childhood trauma is associated with an increased risk of psychosis, but the mechanisms that mediate this relationship are unknown. Exposure to trauma has been hypothesised to lead to cognitive biases that might have causal effects on psychotic symptoms. The literature on whether childhood trauma is associated with psychosis-related cognitive biases has not been comprehensively reviewed. A systematic review and meta-analysis or narrative synthesis of studies examining the association between childhood trauma and the following biases: external locus of control (LOC), external attribution, probabilistic reasoning, source monitoring, top-down processing, and bias against disconfirmatory evidence. Studies were assessed for quality, and sources of heterogeneity were explored. We included 25 studies from 3,465 studies identified. Individuals exposed to childhood trauma reported a more external LOC (14 studies: SMD Median = 0.40, Interquartile range 0.07 to 0.52), consistent with a narrative synthesis of 11 other studies of LOC. There was substantial heterogeneity in the meta-analysis (I2 = 93%) not explained by study characteristics examined. Narrative syntheses for other biases showed weaker, or no evidence of association with trauma. The quality of included studies was generally low. Our review provides some evidence of an association between childhood trauma and a more external LOC, but not with the other biases examined. The low quality and paucity of studies for most of the cognitive biases examined highlights the need for more rigorous studies to determine which biases occur after trauma, and whether they mediate an effect of childhood trauma on psychosis.

Personal resources associated with peripartum depression among mothers of NICU hospitalised preterm infants

OBJECTIVE

The high prevalence of peripartum depression (PPD) among mothers of preterm infants concerns health professionals due to its implications for mothers' and infants' health. A model for explaining PPD, consisting of four personal resources was examined: locus of control, intolerance to uncertainty, maternal self-efficacy, and quality of the couple relationship.

DESIGN

In one of the largest Neonatal Intensive Care Unit (NICU) in Israel, 129 mothers of 215 preterm infants completed self-report questionnaires regarding their background variables, locus of control, intolerance to uncertainty, maternal self-efficacy and quality of couple relationship.

MAIN OUTCOME MEASURES

PPD symptoms and high risk for diagnosing clinical PPD.

RESULTS

The examined personal resources explained 43.9% of the variance in PPD symptoms. Intolerance to uncertainty was positively associated with PPD symptoms, while internal locus of control, high levels of maternal self-efficacy, and high quality of couple relationships were found to be negatively associated with PPD symptoms. Additionally, these variables predicted the likelihood for clinical PPD.

CONCLUSION

The findings indicate a potential likelihood of reducing PPD through healthcare professional interventions, by strengthening personal resources. Associations between personal resources and PPD are discussed in light of the transactional theory of coping.

Temporal trends in psychotic symptoms: Repeated cross-sectional surveys of the population in England 2000-14

BACKGROUND

The number of antipsychotic prescriptions dispensed annually in England has increased substantially over the past decade. It is not known whether this is due to changes in prescribing practices, or an increase in the prevalence of psychosis. To our knowledge, no previous studies have investigated temporal trends in prevalence of psychotic symptoms in non-clinical populations.

METHODS

We used data from the nationally representative Adult Psychiatric Morbidity Surveys 2000, 2007 and 2014 to (1) test whether the prevalence of psychotic symptoms increased between 2000 and 2014; (2) compare prevalence of psychotic symptoms to the prevalence of being prescribed antipsychotic medication; and (3) identify correlates of experiencing psychotic symptoms.

RESULTS

There was a small increase in the prevalence of psychotic symptoms in 2014 compared to 2000 (prevalence in 2000 5.6%, 95% confidence intervals (CI) 5.1% to 6.2%; prevalence in 2014 6.8%, 95% CI 6.1% - 7.6%). This corresponded to an adjusted odds ratio of 1.2 (95% CI 1.02-1.40, p=0.026) for experiencing psychotic symptoms in 2014 compared to 2007. By comparison, antipsychotic medication use doubled over this period (prevalence in 2000 0.6%, 95% CI 0.4%-0.7%; prevalence in 2014 1.2% 95% CI 0.9%-1.5%; aOR 2.22 (1.52-3.25) p<0.001). Correlates of reporting psychotic symptoms included ethnic minority identity, younger age, lower social class, alcohol and cannabis use, and any psychiatric diagnosis.

CONCLUSIONS

While the rates of antipsychotic prescription doubled between 2000 and 2014, the odds of having psychotic symptoms rose only slightly. The reasons for this warrant further investigation.

Bullying Victimization and Developmental Trajectories of Internalizing and Externalizing Problems: The Moderating Role of Locus of Control Among Children

This longitudinal study examined the developmental trajectories of internalizing and externalizing problems, as well as the moderating role of children's locus of control on the relations between traditional and cyberbullying victimization and developmental trajectories of internalizing and externalizing problems. A total of 4180 Chinese elementary school students (M_age = 9.90 years) completed measures of bullying victimization (Time 1), locus of control (Time 1), internalizing and externalizing problems (from Time 1 to Time 5, 6-month intervals). Latent growth curve analyses indicated (a) internalizing problems first gradually decreased and then increased across time, whereas externalizing problems decreased slowly and remained steady over time; (b) both traditional and cyberbullying victimization served as risk factors for internalizing and externalizing problems; however, the effects of traditional bullying victimization on internalizing and externalizing problems were stronger than those for cyberbullying victimization; (c) locus of control moderated the relations between traditional bullying victimization and developmental trajectories of internalizing and externalizing problems. Consistent with cognitive diathesis-stress models, children who experienced higher levels of traditional bullying victimization and reported an external locus of control were more likely to experience internalizing and externalizing problems. This study also identified meaningful gender differences. Implications for the prevention of behavior problems were discussed.

Social communication deficits following early-life deprivation and relation to psychopathology: a randomized clinical trial of foster care

BACKGROUND

Children reared in institutions experience profound deprivation that is linked to impairments in social communication (SC). However, little is known about the long-term consequences of institutional rearing on SC through adolescence, and how SC deficits relate to broad-spectrum psychopathology. It is also unclear whether early removal from deprivation and placement into socially enriched environments remediates these difficulties.

METHODS

Children reared in Romanian institutions from the Bucharest Early Intervention Project were randomly assigned to care as usual or foster care intervention in early childhood. An age- and sex-matched group of never-institutionalized children was also recruited. SC data from 208 children at age 8 and 129 children at 16 were collected using the Social Communication Questionnaire. Psychopathology was assessed as saved factor scores for general (P) and specific internalizing (INT) and externalizing (EXT) problems. We examined (a) whether institutional rearing is associated with continued SC deficits into adolescence; (b) whether early placement into foster care mitigates risk for SC problems; and (c) associations between SC and psychopathology from middle childhood (age 8) to adolescence (age 16).

RESULTS

Findings suggest that: (a) institutionally-reared children have significantly more SC problems than never-institutionalized children at age 16; (b) children placed into foster care early in life have fewer problems with reciprocal social interaction compared to those with prolonged institutional rearing; and (c) deficits in SC at age 8 partially account for the link between institutional rearing and general psychopathology at age 16.

CONCLUSIONS

Early deprivation is associated with impairments in SC that persist into adolescence, with evidence for the remedial benefit of family-based care in the domain of reciprocal social interaction. Moreover, deficits in SC among ever-institutionalized children in middle childhood may increase the risk of broad-spectrum psychopathology in adolescence, thus providing one putative target for early intervention to safeguard against later psychiatric problems.

Markers of Psychosis Risk in the General Population

The categorical approach to defining schizophrenia spectrum disorders requires meeting established criteria. To advance early identification and intervention in young people, the field has progressed to studying help-seeking individuals who are at clinical high risk based on subthreshold psychosis spectrum symptoms, and criteria have been articulated for qualifying individuals as at risk. A broader dimensional examination of psychosis has been applied to population-based studies on non-help seekers. This review highlights the ascertainment and assessment approaches to such population-based studies. Most studies are cross-sectional and rely on questionnaires with limited overlap of tools. However, several consistent findings emerge on symptoms, neurocognitive deficits, and neuroimaging parameters and other biomarkers associated with emergence and persistence of psychotic features. The findings are consistent with the literature on abnormalities associated with schizophrenia, including the presence of neurocognitive deficits; abnormalities in brain structure, function, and connectivity that are related to distress; impairment; and functional outcome. These findings support the validity of studying psychosis experiences during development in a way that can chart the emergence of psychosis in the context of general psychopathology. Such studies are necessary for establishing developmental trajectories that characterize this emergence and for identifying risk and resilience biomarkers moderating or modulating the full range of schizophrenia-related manifestations. More community-based studies are needed, with better standardization and harmonization of measures and incorporating longitudinal follow-up, to establish mechanistic links between cellular-molecular aberrations and specific manifestations of psychosis as envisioned by the precision medicine agenda.

Locus of Control, Self-Control, and Gender as Predictors of Internalizing and Externalizing Problems in Children and Adolescents in Northern Chile

BACKGROUND

Both the control that people attribute to themselves over a situation (locus of control) and the control they attribute to themselves (self-control) have been proposed as aspects that can have an effect on internalizing problems in young people. There is little evidence of this relationship in the infantile-juvenile population in Latin America.

OBJECTIVE

To establish whether there is a significant predictive relationship of locus of control and self-control over internalizing and externalizing problems in the infantile-juvenile population, both at a general level and dimension-specific. These include depression, anxiety, social anxiety, somatic complaints, and post-traumatic stress.

METHODS

A cross-sectional-correlational study was carried out to establish if there was a possible predictive relationship in 3,664 schoolchildren of both primary (4th-6th grade) and secondary (7th-12th grade) in northern Chile, using the short version of the Nowicki-Strickland scale to measure locus of control, the Tangney scale to measure self-control, and the Child and Adolescent Evaluation System (SENA) to measure the dimensions of internalized problems.

HYPOTHESES

(1) Greater self-control is associated with lower levels of internalizing and externalizing problems. (2) Higher external locus of control is associated with higher levels of internalizing and externalizing problems. (3) Self-control, locus of control, and gender can together significantly predict each of the internalizing and externalizing problems.

RESULTS

Evidence is found to support the first two hypotheses fully and partially support the third, since gender did not function as a predictor in all models.

CONCLUSION

The results confirm previous international research in that both locus of control and self-control appear to have a significant influence on internalizing and externalizing problems. Implications for mental health promotion in this population are discussed.

Neighborhood Characteristics at Birth and Positive and Negative Psychotic Symptoms in Adolescence: Findings From the ALSPAC Birth Cohort

BACKGROUND

Urban birth is associated with risk of non-affective psychoses, but the association with subclinical positive and negative symptoms is less clear, despite emerging evidence. Further the extent to which these findings are confounded by polygenic risk scores (PRS) for schizophrenia is also unknown.

METHODS

Using data from the Avon Longitudinal Study of Parents and Children, linked to census geographical indicators, we examined whether various indices of urbanicity at birth were associated with negative and positive psychotic symptoms at age 16 and 18 years, respectively. We used logistic regression models, controlling for child's ethnicity, maternal age, education, marital status, social class, depressive symptoms, other neighborhood exposures, and, in a subsample of children of white ethnicity (N = 10 283), PRS for schizophrenia.

RESULTS

Amongst 11 879 adolescents, those born in the most densely populated tertile had greater odds of reporting positive psychotic experiences, after multivariable adjustment (odds ratio [OR]: 1.57, 95% confidence intervals (CIs): 1.14-2.17). Adolescents born in the most socially fragmented neighborhoods had greater odds of negative symptoms, after multivariable adjustment (OR: 1.43, 95% CI: 1.06-1.85). Although we found that greater schizophrenia PRS were associated with an increased risk of being born in more deprived and fragmented (bot not more densely populated areas), these associations were not confounded by PRS.

INTERPRETATION

Birth into more densely populated and socially fragmented environments increased risk of positive and negative psychotic phenomena in adolescence, respectively, suggesting that different forms of neighborhood social adversity may impinge on different psychopathophysiologies associated with the clinical expression of psychosis.

Terminology and assessment tools of psychosis: A systematic narrative review

AIM

Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'.

METHODS

EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded.

RESULTS

A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization.

DISCUSSION

A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.

Striatal dopamine D2 binding correlates with locus of control: Preliminary evidence from [11C]raclopride Positron Emission Tomography

The ability to exert control has been widely investigated as a hallmark of adaptive behaviour. Dopamine is recognized as the key neuromodulator mediating various control-related processes. The neural mechanisms underlying the subjective perception of being in control, or Locus of Control (LOC) are however less clear. LOC indicates the subjective tendency to attribute environmental outcomes to one's actions (internal LOC) or instead to external incontrollable factors (external LOC). Here we hypothesized that dopamine levels also relate to LOC. Previous work shows that dopamine signaling mediates learning of action-outcome relationships, outcome predictability, and opportunity cost. Prominent theories propose dopamine dysregulation as the key pathogenetic mechanism in schizophrenia and depression. Critically, external LOC is a risk factor for schizophrenia and depression, and predicts increased vulnerability to stress. However, a direct link between LOC and dopamine levels in healthy control had not been demonstrated. The purpose of our study was to investigate this link. Using [¹¹C]raclopride Positron Emission Tomography we tested the relationship between D2 receptor binding in the striatum and LOC (measured with the Rotter Locus of Control scale) in 15 healthy volunteers. Our results show a large and positive correlation: increased striatal D2 binding was associated with External LOC. This finding opens promising avenues for the study of several psychological impairments that have been associated with both dopamine and LOC, such as addiction, schizophrenia, and depression.

Longitudinal associations between psychotic experiences and disordered eating behaviours in adolescence: a UK population-based study

BACKGROUND

Psychotic experiences might represent non-specific markers of poor mental health in adolescence. However, only a few predominantly cross-sectional studies have tested their association with disordered eating behaviours in adolescent and adult populations. The aim of this study was to explore the association between psychotic experiences at age 13 years, and disordered eating behaviours and body-mass index (BMI) at age 18 years.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort based in Avon (England, UK) including mothers with an expected delivery date between April 1, 1991, and Dec 31, 1992, and their children. Psychotic experiences (such as delusions and hallucinations) and BMI were measured at clinical assessments when children were nearly aged 13 years, and data on disordered eating behaviours (ie, presence of binge eating, purging, fasting, or excessive exercise for weight loss; any of these behaviours [included to increase statistical power]; and number of behaviours [included to investigate severity]) were obtained via a postal questionnaire that used adapted questions from the Youth Risk Behaviour Surveillance System questionnaire at approximately age 18 years. For each outcome, we ran a univariable model and four multivariable models (logistic, linear [for BMI], or negative binomial [for the number of behaviours] regression), progressively adjusting for child and maternal sociodemographic, physical, and mental health characteristics (including child's sex, and maternal age, marital status, and highest academic qualification); autistic traits at age 7 years (measured with the Social and Communication Disorder Checklist); baseline BMI at age 13 years, and depressive symptoms at baseline (ie, at age 13 years when psychotic experiences were measured: childs' symptoms measured with the Moods and feelings Questionnaire, and maternal symptoms measured at 32 weeks' gestation with the Edinburgh Postnatal Depression Scale). We imputed missing outcome and covariate data.

FINDINGS

Our sample included 6361 children, of whom 734 (12%) reported psychotic experiences at age 13 years. In univariable models, psychotic experiences were associated with greater odds of reporting any disordered eating behaviours (odds ratio [OR] 1·92, 95% CI 1·46-2·52; p<0·0001), and more severe symptoms (as measured by the number of disordered eating behaviours: 0·58, 0·32-0·84; p<0·0001) at age 18 years. These associations were slightly attenuated by adjustment for maternal and child characteristics (any disordered eating behaviours OR 1·82, 95% CI 1·35-2·44, p<0·0001; number of disordered eating behaviours 0·49, 95% CI 0·23-0·75, p<0·00001), autistic traits at age 7 years (any disordered eating behaviours OR 1·80, 95% CI 1·34-2·41, p<0·0001; number of disordered eating behaviours 0·48, 95% CI 0·22-0·74, p<0·00001), and BMI (any disordered-eating behaviours OR 1·83, 95% CI 1·36-2·46, p<0·0001; number of disordered-eating behaviours 0·32, 95% CI 0·06-0·57, p<0·00001) Adjusting for baseline depressive symptoms attenuated, but not removed, these associations (any disordered eating OR 1·50, 95% CI 1·10-2·03, p=0·010; more severe symptoms 0·32, 0·06-0·57, p=0·017). Psychotic experiences were also associated with greater binge eating, purging, and fasting behaviours, although some associations weakened after controlling for depressive symptoms. We noted no associations between psychotic experiences and excessive exercise or BMI in any of the models.

INTERPRETATION

Our findings suggested that psychotic experiences are markers of increased risk for several disordered eating behaviours in late adolescence, possibly by indicating more severe psychopathology in early adolescence. More research investigating shared risk factors for psychotic experiences and eating disorders is warranted to elucidate shared and specific causal pathways.

FUNDING

Wellcome Trust, the Royal Society, University College London Hospitals National Institute for Health Research Biomedical Research Centre, UK Medical Research Council, and the University of Bristol.

Functional and structural connectivity of the amygdala underpins locus of control in mild cognitive impairment

Locus of control (LOC) is an important personality trait. LOC over cognitive competency reflects an individual's perceived control of desired cognitive outcomes, which is critical for maintaining successful cognitive aging. It is important to understand the neural substrates of LOC over cognitive competency in older adults, especially for individuals at high risk of dementia. Here, we characterized a cohesive functional and structural connectivity profile underlying LOC among 55 older adults with amnestic mild cognitive impairment (aMCI), combining resting-state functional magnetic resonance imaging and diffusion tensor imaging. The results showed that both functional and structural connectivity between the medial prefrontal cortex and amygdala were significantly correlated with external LOC. The functional connectivity mediated the correlation between structural connectivity and external LOC. In addition, aging-associated neurodegeneration moderated the relationship between structural connectivity and external LOC, showing that the structural connectivity was positively correlated with external LOC in low, but not high neurodegeneration. Our results suggest a critical role of the functional amygdala-frontal network, which may serve as a bridge between its white matter tract and LOC over cognitive competency in groups at high risk for dementia.

A longitudinal investigation of childhood communication ability and adolescent psychotic experiences in a community sample

BACKGROUND

Some childhood speech and language impairments precede psychosis but it is not clear whether they also precede adolescent psychotic experiences and whether this association is specific to psychotic experiences.

METHODS

Pragmatic language and expressive speech and language (parent-assessed using the Children's Communication Checklist) at age 9 and psychotic experiences and depression at ages 12 and 18 were investigated in 7659 participants from the Avon Longitudinal Study of Parents and Children. Associations were investigated using multivariate modelling.

RESULTS

Poorer pragmatic language at 9years was associated with psychotic experiences at both ages (12years OR 1.22, 95% CI 1.11, 1.34; 18years OR 1.25, 95% CI 1.10, 1.41) but only with depression at 18years (OR 1.10, 95% CI 1.00, 1.22). Poorer expressive speech and language ability was not associated with psychotic experiences or depression at either age. There was evidence that pragmatic language was specifically associated with psychotic experiences at age 12 but no evidence that the strength of any of the associations changed over time.

CONCLUSIONS

Deficits in pragmatic language precede early and late adolescent psychotic experiences and early adolescent depression. Interventions aimed at helping children improve pragmatic language skills may reduce the incidence of adolescent psychopathology and associated psychological disorder and dysfunction later in life.