The relationship between stressful events, emotion dysregulation, and anxiety symptoms among youth: longitudinal support for stress causation but not stress generation

Examining the Relation Between Prenatal Emotion Dysregulation and Toddler Vocabulary Development: A Biobehavioral Approach

Early language is shaped by parent-child interactions and has been examined in relation to maternal psychopathology and parenting stress. Minimal work has examined the relation between maternal emotion dysregulation and toddler vocabulary development. This longitudinal study examined associations between maternal emotion dysregulation prenatally, maternal everyday stress at 7 months postpartum, and toddler vocabulary at 18 months. Data were collected from 289 typically developing, monolingual children (54% female) and their mothers (63% White and non-Hispanic; 56% held a college degree). During pregnancy, maternal emotion dysregulation was measured via self-report and resting respiratory sinus arrhythmia (RSA). Mothers completed questionnaires about their perceived everyday stress and their child's vocabulary at 7 and 18 months postpartum, respectively. Path analysis revealed that expectant mothers' self-reported emotion dysregulation was indirectly associated with toddlers' expressive vocabulary via their level of postpartum perceived everyday stress. In addition, prenatal maternal resting RSA directly predicted toddlers' expressive vocabulary size. These findings yield insights into the mechanisms by which perinatal mental health may shape early language development and highlight the potential utility of interventions targeting emotion dysregulation during pregnancy.

Functions of consciousness in emotional processing

Contrary to the leading theories of consciousness on offer, it is a fruitful working hypothesis that conscious experiences facilitate a variety of functional capacities that are distinct to particular psychological tasks, individuals, and species (i.e., functional pluralism). In this paper, I illustrate this novel methodological point by identifying some of the functional contributions that consciousness makes to (human) emotional processing. I first consolidate empirical evidence of the capacities and limitations of unconscious emotional processing, drawing on a) experimental paradigms that employ the tools of vision science (masking and suppression of emotionally relevant stimuli), and b) theoretical and clinical research on emotional disorder (Generalized Anxiety Disorder). After comparing the functional characteristics of unconscious and conscious emotional processes, I argue that conscious experiences facilitate a cluster of functions that are specific to emotion, including increased capacities for representing fine-grained evaluative information, inhibition, and flexible response.

Longitudinal interplay between subjective stress, anxiety, depression, and well-being in internet-based stress recovery intervention for nurses

BACKGROUND

Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.

AIM

The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.

METHOD

A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.

RESULTS

The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.

CONCLUSIONS

Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

Unraveling the relationship between stress exposure and childhood anxiety: Considering accumulation, impact, and type in the first five years of life

Exposure to stressful events is linked to anxiety symptoms in children, although research examining this association in the first five years of life is limited. We sought to examine the role of various aspects of family stressful experiences such as the total accumulation, impact, and type (measured longitudinally in the first five years of life) on child anxiety symptoms at age 5 years. A community sample of children and their parents (N = 399) enrolled in a longitudinal study of emotion processing were assessed when the children were infants and at ages 2 years, 3 years, and 5 years. Parents completed the Revised Life Events Questionnaire (all visits) to assess family exposures to stressful life events and the Child Behavior Checklist (5 years) to assess child emotional and behavioral symptoms. Analyses showed that total stressful events accumulated by 4 years were significantly associated with child anxiety symptoms at 5 years (r = 0.118, p = 0.045). Total stressful events accumulated at earlier time points (by 1 year, 2 years, and 3 years of age) were not significantly associated with child anxiety symptoms at 5 years. Events reported as being impactful by families appeared to be more sensitive than total events, with accumulated impactful events as early as 1 year being significantly associated with child anxiety symptoms at 5 years (r = 0.112, p = 0.042). When considering types of stressors, cumulative exposure from the prenatal period to 5 years to financial stressors (β = 0.12, p = .035) was most saliently and significantly associated with child anxiety symptoms at 5 years (after adjusting for other categories of stress such as health, interpersonal, and logistical stressors). Together, these findings suggest that stressful life events accumulated in early life, particularly those rated as impactful for the family and those related to finances, are associated with child anxiety symptoms at 5 years.

Hair Cortisol Concentrations in the Prediction of Early Substance Use Engagement in Youth

OBJECTIVE

Understanding factors associated with early onset of substance use is critical as using alcohol or drugs at a young age is a strong predictor of later substance dependency. Experiencing stressful life events is associated with increased risk for early substance use in youth. Hair cortisol concentration (HCC) is considered a biomarker of psychological stress experienced over longer periods of time. We examined whether HCC could predict early substance use engagement in youth followed over 5 years.

METHODS

Participants were 395 young adolescents (50% female, age range 10-15 years, Mage = 12.3, SD = 1.1 at baseline). Demographic data, socioeconomic factors, and substance use habits were collected at four waves between 2015 and 2021. HCC was assayed from hair collected at a home visit between Wave 1 and Wave 2. Analytic models tested a) HCC in relation to latent class membership of substance use and b) whether HCC moderated the relation between self-reports of stress and substance use.

RESULTS

HCC did not add to the prediction of early substance use engagement in any of the models, while self-reports of stressful life events and everyday discrimination predicted early substance use engagement in the models comparing 'Early' vs 'Late/No' substance use class membership.

CONCLUSION

We found no evidence of HCC to be associated with early substance use engagement in youth. Nevertheless, our results do confirm that self-reports of stressful everyday life experiences predict earlier substance use engagement, underscoring the role of psychosocial stressors as significant predictors of substance use engagement in youth.

Self-Compassion and Emotion Dysregulation Mediate the Effect of Stress Appraisals on Elder Abuse and Neglect Behaviors in Dementia Family Caregiving

OBJECTIVES

The purpose of this paper is to evaluate the mechanistic process by which family caregivers' situational stress appraisals of behavioral symptoms of dementia (BSD) increase the likelihood of a caregiver engaging in abusive and neglectful behaviors toward their care recipient with dementia. We test the hypotheses that (1) the effect of daily BSD stress appraisals on elder abuse and neglect (EAN) is mediated by the caregivers' emotion dysregulation (2) and the mediation path is moderated by self-compassion.

METHODS

This study employed a multitime series design in which participants (N = 453) completed traditional longitudinal surveys at enrollment followed by 21 sequential days of diary surveys (n = 9,513). The hypothesized moderated mediation path was evaluated through a multilevel structural equation model.

RESULTS

Hypotheses were supported. At the within-person level, daily BSD stress appraisal has a significant direct effect on daily EAN. At the between-person level, the path was no longer significant implying a full mediation of emotion dysregulation. The main effect of self-compassion and the interaction term (emotion dysregulation × self-compassion) were also statistically significant indicating the path between emotion dysregulation and EAN is moderated by self-compassion.

DISCUSSION

This study significantly advances the field by empirically showing a mechanistic pathway for a theoretical explanation of EAN. These findings represent a breakthrough for the field and identify modifiable intervention targets for future behavioral interventions to prevent EAN. Emotion (dys)regulation and self-compassion are modifiable traits and skills that can be learned, with robust evidence bases of efficacious interventions that can be adapted for context to dementia family caregiving.

Stress-induced anxiety-related behavior in mice is driven by enhanced excitability of ventral tegmental area GABA neurons

Introduction

Stress and trauma are significant risk factors for many neuropsychiatric disorders and diseases, including anxiety disorders. Stress-induced anxiety symptoms have been attributed to enhanced excitability in circuits controlling fear, anxiety, and aversion. A growing body of evidence has implicated GABAergic neurons of the ventral tegmental area (VTA) in aversion processing and affective behavior.

Methods

We used an unpredictable footshock (uFS) model, together with electrophysiological and behavioral approaches, to investigate the role of VTA GABA neurons in anxiety-related behavior in mice.

Results

One day after a single uFS session, C57BL/6J mice exhibited elevated anxiety-related behavior and VTA GABA neuron excitability. The enhanced excitability of VTA GABA neurons was correlated with increased glutamatergic input and a reduction in postsynaptic signaling mediated via GABAA and GABAB receptors. Chemogenetic activation of VTA GABA neurons was sufficient to increase anxiety-related behavior in stress-naïve mice. In addition, chemogenetic inhibition of VTA GABA neurons suppressed anxiety-related behavior in mice exposed to uFS.

Discussion

These data show that VTA GABA neurons are an early substrate for stress-induced anxiety-related behavior in mice and suggest that approaches mitigating enhanced excitability of VTA GABA neurons may hold promise for the treatment of anxiety provoked by stress and trauma.

Interpersonal sensitivity as a mediator linking interpersonal stressors and social anxiety: Longitudinal mediation analysis using parallel process latent growth curve modeling

BACKGROUND

Little is known about the mechanism between interpersonal stressors and social anxiety in college students. This study was to investigate the mediating effect of interpersonal sensitivity between interpersonal stressors and social anxiety.

METHODS

The data was taken from a large-scale health-related cohort among Chinese college students. This study used data from the first four waves, including 4191 participants. The latent growth curve mediation model was used to examine the potential mediating role of interpersonal sensitivity in the relationship between interpersonal stressors and social anxiety over time.

RESULTS

Both levels and changes in interpersonal stressors were positively associated with subsequent levels and changes in social anxiety. Mediation analysis showed that interpersonal sensitivity mediated the relationship between interpersonal stressors and social anxiety.

LIMITATION

All variables were collected based on self-report.

CONCLUSIONS

Interpersonal stressor is a significant risk factor for social anxiety, and this association appears to be mediated by interpersonal sensitivity. It is necessary to evaluate and intervene against interpersonal sensitivity related to interpersonal stressors for the prevention of social anxiety.

Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning

Background: The association between stressful life events (SLEs) and adolescent anxiety symptoms has been extensively studied, but the specific impacts of different SLEs domains remain inconclusive. Moreover, limited research has examined the role of family functioning in these associations.Objective: This study aimed to investigate the associations between various recent SLEs and adolescent anxiety symptoms and explore the role of family functioning.Methods: Data were obtained from the second phase of the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research in Guangzhou, China. A total of 10,985 students (51.9% boys; mean [SD] age, 15.3 [1.5] years) from forty middle schools participated in the study in 2022 and completed a self-report questionnaire assessing anxiety symptoms, SLEs, and family functioning using the Generalized Anxiety Disorder-7 (GAD-7), Adolescent Self-rating Life Events Checklist (ASLEC; including five subscales: interpersonal stress, academic stress, punishment-related stress, loss-related stress, and adaptation-related stress), and the adapted Chinese version of the Family Assessment Device (FAD), respectively. Linear mixed-effects models were performed and the moderation role of family functioning was also examined.Results: The fully adjusted model revealed that a 1-SD increase in the overall ASLEC score was associated with higher levels of anxiety symptoms (β = 2.23, 95%CI: 2.15-2.32). Among various SLEs domains, the academic domain shows the most significant association (β = 2.25, 95%CI: 2.17-2.33). Family functioning exerted an independent protective influence on anxiety symptoms, with each 1-SD increase in FAD scores negatively associated with anxiety symptoms (β = -2.11, 95%CI: - 2.29 to - 1.93) in the adjusted model. Moreover, family functioning significantly buffered the impacts of overall SLEs and each domain, except for adaptation-related SLEs, on anxiety symptoms.Conclusion: Higher recent SLEs levels were associated with increased anxiety symptoms among adolescents, with academic SLEs showing the greatest association. Positive family functioning had both direct and buffering influences on anxiety symptoms.

The influence of stress on mental health among Chinese college students: The moderating role of psychological suzhi

Depending on its duration, stress can be divided into chronic and acute stress, both of which can be detrimental to an individual's mental health. Psychological suzhi may act as a protective factor that buffers the adverse effects of stress. This study aimed to explore the moderating role of psychological suzhi in the relationship between these two types of stress and mental health based on a dual-factor model of mental health. Study 1 explored the moderating role of psychological suzhi on the relationship between chronic stress and mental health using the Adolescent Self-Rating Life Events Check List, College Student Psychological Suzhi Scale Brief Mental Health Version, Satisfaction With Life Scale, and 12-item General Health Questionnaire to investigate 919 Chinese college students. A hierarchical regression model was used to examine the moderating effects. Study 2 examined the moderating role of psychological suzhi on the relationship between acute stress and mental health. Participants (N = 56) were classified into high (N = 30) and low (N = 26) psychological suzhi groups based on the Psychological Suzhi Scale. They completed the Trier Social Stress Test for Groups and a specific control condition, and their state anxiety and happiness levels were assessed. Data were analyzed using a mixed-design repeated-measures ANOVA. The results of Study 1 revealed that psychological suzhi moderated the influence of chronic stress on the negative indicator of mental health (psychological symptoms) (β = -0.18, t = -6.90, p < 0.001). The results of Study 2 showed that psychological suzhi moderated the effect of acute stress on the negative indicator of mental health (state anxiety) [F (1, 54) = 4.79, p < 0.05, η2 = 0.08]. Psychological suzhi can moderate the influence of both chronic and acute stress on the negative indicators of college students' mental health but cannot moderate the influence on the positive indicators of mental health.

Multidimensional stressors and depressive and anxiety symptoms in adolescents: A network analysis through simulations

BACKGROUND

Existing research has established associations between various stressors and adolescent mental health, primarily from a variable-level perspective. However, a symptom-level understanding about which stressors and symptoms might play a important role is scarce.

METHODS

The sample consisted of 15,570 adolescents aged 10 to 19. Participants completed questionnaires which assessed multidimensional stressors, depressive symptoms, anxiety symptoms, and demographic information. Network analysis was conducted to explore the relationships between stressors and depressive and anxiety symptoms. Additionally, to identify effective targets for the treatment and prevention of adolescent mental health issues, symptom-specific intervention simulations were performed on the network to investigate changes in symptom values in response to the alleviation and aggravation of specific stressors and symptoms.

RESULTS

Findings revealed that academic stressors exhibited stronger associations with anxiety symptoms than other stressors, particularly nervousness. Family relationships were more closely linked to depressive symptoms than other stressors, particularly suicidal ideation. Academic stressors emerged as an effective intervention target, and uncontrollable worry as an important prevention target. With the exception of academic stressors, simulating aggravation interventions on symptoms resulted in more changes in overall symptom activation than alleviation interventions.

LIMITATIONS

A cross-sectional design did not uncover network changes over time and the sample was non-clinical.

CONCLUSIONS

This study highlights the importance of addressing academic stressors to alleviate adolescents' depressive and anxiety symptoms and reveals that uncontrollable worry is a key prevention target. The findings are helpful for clinicians and educators to develop effective strategies to protect adolescents' mental health.

Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study

The COVID-19 pandemic, and the response of governments to mitigate the pandemic's spread, resulted in exceptional circumstances that comprised a major global stressor, with broad implications for mental health. We aimed to delineate anxiety trajectories over three time-points in the first 6 months of the pandemic and identify baseline risk and resilience factors that predicted anxiety trajectories. Within weeks of the pandemic onset, we established a website (covid19resilience.org), and enrolled 1362 participants (n = 1064 from US; n = 222 from Israel) who provided longitudinal data between April-September 2020. We used latent growth mixture modelling to identify anxiety trajectories and ran multivariate regression models to compare characteristics between trajectory classes. A four-class model best fit the data, including a resilient trajectory (stable low anxiety) the most common (n = 961, 75.08%), and chronic anxiety (n = 149, 11.64%), recovery (n = 96, 7.50%) and delayed anxiety (n = 74, 5.78%) trajectories. Resilient participants were older, not living alone, with higher income, more education, and reported fewer COVID-19 worries and better sleep quality. Higher resilience factors' scores, specifically greater emotion regulation and lower conflict relationships, also uniquely distinguished the resilient trajectory. Results are consistent with the pre-pandemic resilience literature suggesting that most individuals show stable mental health in the face of stressful events. Findings can inform preventative interventions for improved mental health.

Assessment of Youth Coping and Appraisals Through a Timelining Activity: Validation and Utility of a Tool for Pediatric Research and Practice

INTRODUCTION

Many tools to assess coping in youth fail to engage youth meaningfully in the assessment process. This study aimed to evaluate a brief timeline activity as an interactive way to assess appraisal and coping in pediatric research and practice.

METHOD

We used a mixed method convergent design to collect and analyze survey and interview data from 231 youths aged 8-17 years in a community-based setting.

RESULTS

The youth engaged readily in the timeline activity and found the activity easy to understand. Relationships among appraisal, coping, subjective well-being and depression were in the hypothesized directions, suggesting the tool supports a valid assessment of appraisals and coping in this age group.

DISCUSSION

The timelining activity is well-accepted by youth and supports reflexivity, prompting youth to share insights on strengths and resilience. The tool may augment existing practices for assessing and intervening in youth mental health in research and practice.

Examining the associations between physical activity, self-esteem, perceived stress, and internalizing symptoms among older adolescents

INTRODUCTION

In older adolescence, stress has been found to be prevalent. It has been seen that higher physical activity (PA) relates to lower stress levels, which, in turn, relates to fewer anxiety and depressive symptoms (internalizing symptoms). However, how these associations function is not fully understood. PA is strongly associated with greater self-esteem in adolescents. As greater self-esteem is thought to aid better coping with stress and has been seen as beneficial for mental health in adolescents, PA may be associated with lower stress and better mental health through self-esteem and more adaptive stress appraisals. Therefore, the aim of the study was to examine the relationships between PA, self-esteem, stress, and mental health.

METHODS

A cross-sectional design was employed, and path analysis was implemented. PA, self-esteem, stress appraisals, distress tolerance, perceived stress, anxiety, and depression were assessed using online questionnaires from 244 adolescent participants from the United Kingdom (aged 15-19, M = 16.75 [SD = 0.82], 145 female).

RESULTS

Path analysis revealed that PA was associated with lower perceived stress through increased self-esteem, adaptive appraisals, and higher distress tolerance (total standardized indirect effect; p = .007 (-0.25 to -0.11). Moreover, lower perceived stress was associated with lower anxiety (standardized direct effect; p < .001 [2.65-4.0] and depressive symptoms (standardized direct effect; p < .001 [0.33-0.63]).

CONCLUSIONS

Findings suggest that higher PA could be effective in improving mental health among older adolescents, due to its association with perceived stress through higher self-esteem and more adaptive appraisals of stress.

Association between academic pressure, NR3C1 gene methylation, and anxiety symptoms among Chinese adolescents: a nested case-control study

BACKGROUND

Academic pressure is a prevalent stressor among Chinese adolescents and is often linked to anxiety symptoms, although the underlying mechanism remains unclear. This study aimed to investigate the association between NR3C1 gene methylation, academic pressure, and anxiety symptoms among Chinese adolescents.

METHODS

This nested-case control study included 150 adolescents (boys: 38.7%; baseline age: 12-17 years) from a school-based longitudinal study of Chinese adolescents. Cases (n = 50) were defined as those with anxiety symptoms at both baseline and follow-up, while controls (n = 100) were randomly selected from those without anxiety symptoms at both timepoints. The cases and controls were 1:2 matched by age. Academic pressure, anxiety symptoms, and potential covariates were measured using a self-report questionnaire. Peripheral whole blood samples were collected from each participant for the detection of cortisol level (i.e., morning serum cortisol level) and DNA methylation. The methylation analysis included a total of 27 CpG units at the NR3C1 promoter region.

RESULTS

The final adjusted models showed that students with heavy academic pressure at baseline were at a higher risk of anxiety symptoms at follow-up compared to those with mild academic pressure (β estimate: 6.24 [95% CI: 3.48 ~ 9.01]). After adjusting for covariates, the methylation level of one CpG unit (NR3C1-16 CpG10) in NR3C1 differed significantly between cases and controls (F = 6.188, P = 0.014), and the difference remained significant after correction for multiple testing (P < 0.025). The adjusted regression models showed that moderate (β estimate = 0.010 [95% CI: 0.000 ~ 0.020], P = 0.046) and heavy (β estimate = 0.011 [95% CI: 0.001 ~ 0.020], P = 0.030) academic pressure were significantly associated with the methylation level of NR3C1-16 CpG 10. Further mediation analysis demonstrated that the association of academic pressure and anxiety symptoms was significantly mediated by the methylation of NR3C1-16 CpG 10 (β estimate for indirect effect = 0.11 [95% CI: 0.005 ~ 0.32]; indirect/total effect = 8.3%).

CONCLUSION

The present study suggests that NR3C1-16 CpG 10 DNA methylation might be a potential mechanism that partially explains the lasting effects of academic pressure on subsequent anxiety symptoms among adolescents. Further studies with larger sample sizes are recommended to replicate this finding.

Youth stress generation: an examination of the role of anxiety, anxiety symptoms and cognitive distortions

INTRODUCTION

Stress generation suggests a reciprocal relationship between depression and prospective stressful life events. However, the applicability of stress generation to anxiety disorders has been understudied, particularly among youth. We address this gap by examining stress generation in youth at high-risk of developing anxiety disorders.

METHODS

Participants were one-hundred thirty-six at-risk youth (M age = 8.69, 84.6% Caucasian; 55.9% female), each of whom had a parent with an anxiety disorder. We examined the role of an anxiety disorder diagnosis, anxiety symptoms, and cognitive distortions in youth's prospective one and six-year stressful life events (i.e., stress generation).

RESULTS

Anxiety symptoms and cognitive distortions were significant predictors of one-year total dependent stress. Anxiety diagnosis and anxiety symptoms were significant predictors of one-year dependent interpersonal stress. Anxiety diagnosis and anxiety symptoms were significant predictors of six-year independent stress.

CONCLUSION

Support for the stress generation model was found in high-risk youth, but only over a one-year period. This suggests important effects of anxiety and cognitive distortions on stress generation, though their implications might be time-capped.

Family-based care buffers the stress sensitizing effect of early deprivation on executive functioning difficulties in adolescence

We examined whether family care following early-life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were randomly assigned to foster care or care-as-usual; 72 never-institutionalized children served as a comparison group. At age 16 years, adolescents (n = 143; 54% female; 67.1% Romanian) self-reported recent SLEs, completed a battery of memory and EF tasks, and completed a go/nogo task in which mediofrontal theta power (MFTP) was measured using electroencephalogram. More independent SLEs predicted lower EF and more dependent SLEs predicted lower MFTP, but only among adolescents with prolonged early deprivation. Findings provide preliminary evidence that family care following early deprivation may facilitate resilience against stress during adolescence on EF.

Longitudinal changes in fear and anxiety among Chinese college students during the COVID-19 pandemic: a one-year follow-up study

There is growing evidence that levels of fear and anxiety have increased during the COVID-19 pandemic. However, given regular epidemic prevention and control measures, longitudinal changes and causal factors in the incidence of fear and anxiety need to be measured and explored. College students completed online surveys in two wave studies a year apart. The participants who completed both of the surveys numbered 22,578. The online surveys were completed at the pandemic's normalization/prevention stage (T1, from June 1 to 15, 2020) and during a phase of new local transmission of the disease in Guangdong Province (T2, from June 10 to 18, 2021). Multiple linear regressions were used to examine fear and anxiety predictors from demographic characteristics. Fear related to COVID-19 had significantly decreased at T2 (t = 66.64, p < 0.001), however, anxiety had significantly increased at T2 (t = -5.03, p < 0.001). In particular, not implementing preventive measures (e.g., handwashing) during the COVID-19 pandemic had the greatest impact in predicting the change in fear levels. By contrast, prior poor mental health status contributed the most in predicting the change in degree of anxiety. These results suggest different changes in anxiety levels (deterioration) and degree of fear (mitigation) occurred as the COVID-19 pandemic progressed. These findings have implications for planning mental health crisis provisions and have long-term impact beyond this pandemic.

The relationship between adolescent emotion dysregulation and problematic technology use: Systematic review of the empirical literature

BACKGROUND AND AIMS

We aimed to systematically identify, evaluate and summarize the research on adolescent emotion dysregulation and problematic technology use. We critically appraise strengths and limitations and provide recommendations for future research.

METHODS

We followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and conducted a systematic review of published original reports on adolescent emotion dysregulation and problematic technology use published until March 1, 2022. A thorough search preceded the selection of studies matching prespecified criteria. Strengths and limitations of selected studies, regarding design and reporting, were identified based on current best practices.

RESULTS

39 studies met inclusion criteria. All of these studies provided on the relationship between adolescent emotion dysregulation and problematic technology use severity based on self-report data.

DISCUSSION

There was a positive correlation between adolescent emotion dysregulation and the severity of problematic technology use. Beyond this, other variables (such as anxiety, depression, self-esteem, etc.) were also closely related to emotion dysregulation and problematic technology use. Such studies are of importance to better understand cause-effect relations regarding both variables.

The Relationship Between Fears of Compassion, Emotion Regulation Difficulties, and Emotional Eating in College Students: A Moderated Mediation Model

Although previous research has found the impact of fears of compassion on eating disorders, the mechanism underlying the relationship between fears of compassion and emotional eating remains to be examined. This study aimed to examine the mediating role of emotion regulation difficulties in the relationships between fears of compassion and emotional eating in college students, as well as the gender difference in the mediation model. The Fears of Compassion Scale, Difficulties in Emotion Regulation Scale, and Dutch Eating Behavior Questionnaire were completed by 673 college students in Fujian Province, China. Structural Equation Modeling was primarily employed to analyze the data. The results showed that both fear of compassion for self and fear of compassion from others were positively associated with emotion regulation difficulties, which in turn were related to emotional eating for female college students. Emotion regulation difficulties played a significant mediating effect in the relationship between fears of compassion and emotional eating. Comparatively, for male college students, only fear of compassion for self was positively associated with emotion regulation difficulties, but emotion regulation difficulties were not related to emotion eating. Moreover, the mediating effect of emotion regulation difficulties was not significant in the relationship between fears of compassion and emotion eating for male college students. The findings suggest that it is important to improve individuals' fears of compassion to reduce emotional eating, particularly for female college students.

An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial

BACKGROUND

Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot-in the form of an interactive plush toy-that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children's emotion regulation routines, there is no quantitative evidence of the intervention's impact on child outcomes.

OBJECTIVE

The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation-Purrble-that can be deployed across prevention and treatment contexts.

METHODS

Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents' rating of child dysregulation will be ≥10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child's emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis.

RESULTS

The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022.

CONCLUSIONS

This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28914.

Generalized Anxiety among Swiss Health Professions and Non-Health Professions Students: An Open Cohort Study over 14 Months in the COVID-19 Pandemic

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4–20.7) in HP students and 24.4% (95% CI = 22.3–26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3–29.5) and 36.9% (95% CI = 32.9–40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.

A Longitudinal Study on Generalized Anxiety Among University Students During the First Wave of the COVID-19 Pandemic in Switzerland

OBJECTIVE

The COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic.

METHODS

676 students (76% females) at Zurich University of Applied Sciences participated in the first (T0) and second (T1) survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7 (GAD-7). Risk and protective factors (e.g., COVID-19-related variables) were examined.

RESULTS

GAD-7 scores decreased significantly from T0 to T1 (mean change: -0.446, SE = 0.132, 95% CI: -0.706, -0.186, t = -3.371, df = 659, p = 0.001). Participants with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants' concern about their own health, and interaction between time and participants' concern about their own health. Resilience and social support negatively predicted anxiety.

CONCLUSIONS

Our findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency.