Development and validation of new anxiety and bipolar symptom scales for an expanded version of the IDAS (the IDAS-II)

From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women

BACKGROUND

Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood.

METHODS

Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum.

RESULTS

Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period.

LIMITATIONS

Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed.

CONCLUSIONS

Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.

Neural response to monetary and social rewards and familial risk for psychopathology in adolescent females

BACKGROUND

Adolescence is a key developmental period for the emergence of psychopathology. Reward-related brain activity increases across adolescence and has been identified as a potential neurobiological mechanism of risk for different forms of psychopathology. The reward positivity (RewP) is an event-related potential component that indexes reward system activation and has been associated with both concurrent and family history of psychopathology. However, it is unclear whether the RewP is also associated with higher-order psychopathology subfactors and whether this relationship is present across different types of reward.

METHODS

In a sample of 193 adolescent females and a biological parent, the present study examined the association between adolescent and parental psychopathology subfactors and adolescent RewP to monetary and social reward.

RESULTS

Results indicated that the adolescent and parental distress subfactors were negatively associated with the adolescent domain-general RewP. The adolescent and parental positive mood subfactors were negatively associated with the adolescent domain-general and domain-specific monetary RewP, respectively. Conversely, the adolescent and parental fear/obsessions subfactors were positively associated with the adolescent domain-general RewP. The associations between parental and adolescent psychopathology subfactors and the adolescent RewP were independent of each other.

CONCLUSIONS

The RewP in adolescent females is associated with both concurrent and parental psychopathology symptoms, suggesting that it indexes both severity and risk for higher-order subfactors.

Longitudinal associations between sense of belonging, imposter syndrome, and first-year college students' mental health

Objective: The first year of college is a time of major changes in social dynamics, raising questions about ways to promote students' mental health. We examined longitudinal associations between students' sense of belonging, imposter syndrome, depressive symptoms, and well-being. Participants: Fifty-eight first-year college students at a university in the United States participated in the study. Methods: Students completed questionnaires during the first 6 months of college (T1) and at the end of the academic year (T2). Results: Greater sense of social and academic belonging was correlated with lower imposter syndrome, depression, and greater well-being at T1. Accounting for T1 measures, lower imposter syndrome predicted greater well-being but not depression at T2. Accounting for T1 mental health, belonging was not a significant predictor of depression or well-being at T2. Conclusion: Increasing sense of belonging and addressing imposter syndrome early in the transition to college may be critical in promoting mental health.

Uncertainty and anxiety: Evolution and neurobiology

Anxiety is a complex phenomenon: Its eliciting stimuli and circumstances, component behaviors, and functional consequences are only slowly coming to be understood. Here, we examine defense systems from field studies; laboratory studies focusing on experimental analyses of behavior; and, the fear conditioning literature, with a focus on the role of uncertainty in promoting an anxiety pattern that involves high rates of stimulus generalization and resistance to extinction. Respectively, these different areas provide information on evolved elicitors of defense (field studies); outline a defense system focused on obtaining information about uncertain threat (ethoexperimental analyses); and, provide a simple, well-researched, easily measured paradigm for analysis of nonassociative stress-enhanced fear conditioning (the SEFL). Results suggest that all of these-each of which is responsive to uncertainty-play multiple and interactive roles in anxiety. Brain system findings for some relevant models are reviewed, with suggestions that further analyses of current models may be capable of providing a great deal of additional information about these complex interactions and their underlying biology.

Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment

OBJECTIVE

Certain symptom and risk/maintenance factor similarities between individuals with atypical anorexia nervosa (AN) and 'typical' AN have been documented, but few studies have investigated how atypical AN compares to bulimia nervosa (BN). Further, the role of affective mechanisms in maintaining restrictive eating in atypical AN has not been examined. The current study investigated whether atypical AN resembles AN and/or BN on affect-related processes using questionnaires and ecological momentary assessment (EMA).

METHOD

Women with atypical AN (n = 24), AN-restrictive subtype, (n = 27), AN-binge eating/purging subtype (n = 34), and BN (n = 58) completed questionnaires measuring depressive symptoms and emotion regulation difficulties. They also completed a 14-day EMA protocol during which they reported negative and positive affect and skipped meals five times/day (signal-contingent surveys) and restrictive eating after meals/snacks (event-contingent surveys).

RESULTS

Diagnostic groups generally did not differ on questionnaire measures nor affective patterns surrounding restrictive eating behaviors. Momentary changes in affect did not predict or follow restriction at meals/snacks, though higher momentary negative affect ratings predicted skipped meals, and higher positive affect was reported after skipped meals. Greater average negative affect and lower average positive affect predicted both restrictive eating behaviors.

DISCUSSION

Across diagnoses, reductions in food intake do not appear to be influenced by momentary changes in affect, though skipping meals may serve an emotion regulation function. Atypical AN seems to resemble AN and BN on affective processes underlying restrictive eating, raising further questions regarding the unique diagnosis of atypical AN.

PUBLIC SIGNIFICANCE

Though atypical anorexia appears to strongly resemble anorexia nervosa, it is less clear how this disorder relates to bulimia nervosa. It is further unknown whether affective-related processes underlie restrictive eating in atypical anorexia nervosa, and how these processes compare to those in anorexia nervosa and bulimia nervosa. Results suggest that atypical anorexia does not differ from anorexia nervosa or bulimia nervosa on emotion-related measures, nor in affective patterns surrounding restrictive eating behaviors.

A Psychometric Evaluation of the Expanded Version of the Inventory of Depression and Anxiety Symptoms (IDAS-II) in Children and Adolescents

The expanded version of the Inventory of Depression and Anxiety Symptoms (IDAS-II) is a self-report measure of 18 empirically derived internalizing symptom dimensions. The measure has shown good psychometric properties in adults but has never been evaluated in children and adolescents. A Swedish version of the IDAS-II was administered to 633 children and adolescents (Mage =16.6 [SD = 2.0]) and 203 adults (Mage = 35.4 [SD = 12.1]). The model/data fit of the 18-factor structure was excellent in both samples and measurement invariance across age groups was supported. All scales showed good to excellent internal consistency and psychometric properties replicated in the younger youth sample (< 16 years). Among youth, good convergent validity was established for all scales and divergent validity for most scales. The IDAS-II was better at identifying youth with current mental health problems than an internationally recommended scale of internalizing symptoms. In conclusion, the IDAS-II shows promise as a measure of internalizing symptoms in youth.

Negative Mood Dysregulation Loads Strongly Onto Common Factors With Many Forms of Psychopathology: Considerations for Assessing Nonspecific Symptoms

There have been proposals to expand definitions for categorical disorders and dimensionally conceptualized syndromes (e.g., psychopathy) to include negative mood lability and dysregulation (NMD). Factor analytic results are often presented in support of these proposals, and we provide factor analytic demonstrations across clinically oriented samples showing that NMD indicators load strongly onto factors with a range of psychopathology. This is unsurprising from a transdiagnostic perspective but shows that factor analysis could potentially be used to justify expanding definitions for specific constructs even though NMD indicators show strong, nonspecific loadings on psychopathology factors ranging widely in nature. Expanding construct definitions and assessment approaches to emphasize NMD also may negatively impact discriminant validity. We agree that targeting NMD is essential for comprehensive assessment, but our demonstrative analyses highlight a need for using factor analysis and other statistical methods in a careful, theoretically driven manner when evaluating psychopathology structure and developing measures.

Obsessive-compulsive disorder symptoms and intrusive thoughts in the postpartum period: Associations with trauma exposure and PTSD symptoms

In a community sample of trauma-exposed postpartum individuals (N = 167; mean age = 30, 90% White; 61.7% completed bachelor's degree or higher) longitudinally completed self-report measures on PTSD, depressive, and Obsessive-compulsive disorder (OCD) symptoms (specifically checking, ordering, washing, and obsessing symptoms), preoccupation with intrusive postpartum thoughts/neutralising strategies, and trauma exposure at 4 and 12 weeks postpartum. PTSD symptoms were strongly associated with all OCD symptoms (r = 0.32- 0.49, p < 0.001), preoccupation with postpartum-specific intrusive thoughts (r = 0.32-0.45, p < 0.001), and preoccupation with neutralising strategies (r = 0.21-0.29, p < 0.05) at both time points. PTSD symptoms were also predictive of checking and obsessing symptoms. This study identified PTSD symptoms as a new correlate for preoccupation with postpartum-specific intrusive thoughts and neutralising strategies in the postpartum period in a community sample. These findings add to the evidence suggesting a strong association between PTSD and OCD symptoms across the lifespan, including in non-clinical samples. Future research should examine best practices to assess and treat a variety of postpartum psychopathology symptoms, not just depression.

Impact of COVID-19 on the Self-Report Assessment of Obsessive-Compulsive Disorder

Background The COVID-19 pandemic and subsequent guidelines have had a substantial effect on social norms. This likely affected self-report assessment of psychopathology, namely those that assess obsessive-compulsive tendencies routinely used to screen for obsessive-compulsive disorder (OCD). It was hypothesized that self-report assessment of OCD likely produces inflated, non-discriminating scale scores. Methods Data collection occurred prior to the COVID-19 pandemic with the aim of validating a new psychological test; however, data collection was abruptly halted in March 2020. Data collection was allowed to resume in the latter half of the year. Both groups were racio-ethnically and gender diverse. Results Self-report measures of OCD yielded inflated scores. For instance, the total obsessive-compulsive inventory-revised (OCI-R) average score of all participants went from normative levels prior to COVID-19 (M = 13.69, SD = 10.32) to an average score that was above the clinical cut-off on the OCI-R (M = 32.89; SD = 12.95) during the pandemic (t(135) = 9.66, p < 0.001, Cohen's d = 1.66). Conclusions OCD-related scale scores likely produced false positives in research and practice due to COVID-19 health guidelines put in place to protect against infection that may otherwise be considered contamination fears on OCD measures.

Development of a multivariate prediction model for antidepressant resistant depression using reward-related predictors

Introduction

Individuals with depression who do not respond to two or more courses of serotonergic antidepressants tend to have greater deficits in reward processing and greater internalizing symptoms, yet there is no validated self-report method to determine the likelihood of treatment resistance based on these symptom dimensions.

Methods

This online case-control study leverages machine learning techniques to identify differences in self-reported anhedonia and internalizing symptom profiles of antidepressant non-responders compared to responders and healthy controls, as an initial proof-of-concept for relating these indicators to medication responsiveness. Random forest classifiers were used to identify a subset from a set of 24 reward predictors that distinguished among serotonergic medication resistant, non-resistant, and non-depressed individuals recruited online (N = 393). Feature selection was implemented to refine model prediction and improve interpretability.

Results

Accuracies for full predictor models ranged from .54 to .71, while feature selected models retained 3-5 predictors and generated accuracies of .42 to .70. Several models performed significantly above chance. Sensitivity for non-responders was greatest after feature selection when compared to only responders, reaching .82 with 3 predictors. The predictors retained from feature selection were then explored using factor analysis at the item level and cluster analysis of the full data to determine empirically driven data structures.

Discussion

Non-responders displayed 3 distinct symptom profiles along internalizing dimensions of anxiety, anhedonia, motivation, and cognitive function. Results should be replicated in a prospective cohort sample for predictive validity; however, this study demonstrates validity for using a limited anhedonia and internalizing self-report instrument for distinguishing between antidepressant resistant and responsive depression profiles.

The Brief Emotion Dysregulation Scale: Development, Preliminary Validation, and Recommendations for Use

Emotion dysregulation is a multi-faceted, transdiagnostic construct, and its assessment is crucial for characterizing its role in the development, maintenance, and treatment of psychiatric problems. We developed the Brief Emotion Dysregulation Scale (BEDS) to capture four components of emotion dysregulation: sensitivity, lability, reactivity, and consequences. We examined factor structure and construct validity in four independent samples of college students (N = 1,485). We elected to treat consequences as a separate index of problems associated with emotion dysregulation. Exploratory and confirmatory factor analyses did not support the reactivity subscale and instead supported a well-fitting two-factor solution for sensitivity and lability. Multi-group analyses demonstrated strong factorial invariance by gender. The resulting 12-item BEDS includes sensitivity and lability subscales and a separate consequences scale to indicate associated problems. Convergent correlations suggested good construct validity. This provides preliminary support for the BEDS as a brief transdiagnostic screening tool for emotion dysregulation and associated consequences.

Incremental Contribution of the Minnesota Multiphasic Personality Inventory - 3 to Predicting One-Year Postoperative Spinal Cord Surgery/Spinal Cord Stimulation Outcomes

Pre-surgical psychological assessments are becoming common in the United States and are recommended or required prior to surgical/spinal cord stimulator intervention for chronic back pain. Psychological testing is often recommended for these evaluations and the various versions of the Minnesota Multiphasic Personality Inventory (MMPI) have demonstrated utility for predicting outcomes in this setting. This investigation sought to extend that literature with the newest version of the MMPI, the MMPI-3. The sample comprised of 909 patients (50.5% men, 49.5% women) who consented to participating in an outcome study and took the MMPI-3 along with other self-report measures of pain, functional disability, and emotional functioning prior to surgery as part of their pre-surgical psychological assessment. Self-report measures of pain, functional disability, and emotional functioning were administered again one-year following the intervention. MMPI-3 scale scores accounted for up to 9% of additional variance in the outcomes after controlling for pre-surgical measures. Measures of emotional/internalizing dysfunction, somatic dysfunction, and, to a lesser extent, behavioral/externalizing dysfunction contributed the most to the prediction of poorer outcomes.

Developmental pathway for first onset of depressive disorders in females: from adolescence to emerging adulthood

BACKGROUND

Although risk markers for depressive disorders (DD) are dynamic, especially during adolescence, few studies have examined how change in risk levels during adolescence predict DD onset during transition to adulthood. We compared two competing hypotheses of the dynamic effects of risk. The risk escalation hypothesis posits that worsening of risk predicts DD onset beyond risk level. The chronic risk hypothesis posits that persistently elevated risk level, rather than risk change, predicts DD onset.

METHODS

Our sample included 393 girls (baseline age 13.5-15.5 years) from the adolescent development of emotions and personality traits project. Participants underwent five diagnostic interviews and assessments of risk markers for DD at 9-month intervals and were re-interviewed at a 6-year follow-up. We focused on 17 well-established risk markers. For each risk marker, we examined the prospective effects of risk level and change on first DD onset at wave six, estimated by growth curve modeling using data from the first five waves.

RESULTS

For 13 of the 17 depression risk markers, elevated levels of risk during adolescence, but not change in risk, predicted first DD onset during transition to adulthood, supporting the chronic risk hypothesis. Minimal evidence was found for the risk escalation hypothesis.

CONCLUSIONS

Participants who had a first DD onset during transition to adulthood have exhibited elevated levels of risk throughout adolescence. Researchers and practitioners should administer multiple assessments and focus on persistently elevated levels of risk to identify individuals who are most likely to develop DD and to provide targeted DD prevention.

Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period

OBJECTIVES

Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance.

METHOD

Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive).

RESULTS

During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear.

CONCLUSION

It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Clinical and psychological implications of post-traumatic stress in firefighters: a moderated network study

Firefighters are frequently exposed to trauma and may experience a unique symptom presentation of post-traumatic stress. Prior research has identified stronger associations between certain post-traumatic stress symptoms (e.g. detachment, intrusions, physiological reactivity) using network analysis. However, little is known about the effects of symptom severity and emergency work-related trauma on symptom networks. The present study probed the network structure of post-traumatic stress symptoms in trauma-exposed firefighters (N = 871) to model the dynamic interactions of psychological symptoms. We developed a network of post-traumatic stress symptoms and a network of post-traumatic stress with clinical covariates and used moderated network modelling to assess the effects of having PTSD and experiencing work-related trauma on the networks. We identified high edge correlations between several nodes (e.g. startle/hypervigilance, internal/external cue avoidance, detachment/lack of interest) and high centrality of detachment, external cue avoidance, and flashbacks. Additionally, having PTSD moderated positive network associations between risk-taking and suicidality and between distorted blame and post-traumatic cognitions. Work-related trauma moderated negative associations between appetite gain and loss and appetite loss and suicidality. Findings suggest that targeting specific symptoms of detachment, external cue avoidance, and flashbacks could allow for the development of effective trauma-informed interventions for these populations.

Mapping the Relationship between Health-related Beliefs, Fear, Avoidance, and Depression: Lessons from the Pandemic and Beyond

The COVID-19 pandemic brought a mental health crisis, with depression symptoms increasing nearly three-fold compared to pre-pandemic levels. To explain this surge and to outline related novel treatment targets for post-pandemic psychiatric interventions, the current study examined cognitive, emotional, and behavioral predictors of depression (in the context of the recent pandemic). Participants completed measures assessing perceived danger, perceived infectiousness, and fear of the coronavirus (COVID-19). Participants also reported symptoms of depression and behavioral tendencies: pandemic-related compulsive checking, cleaning, and avoidance (of activities, situations, places, and people). A multiple mediation model revealed that the relationship between perceived infectiousness of the virus and depression was atemporally mediated by fear of the virus and pandemic-related avoidance of activities, situations, places, and people. Furthermore, avoidance played a uniquely important role in the mediation model. First, it directly mediated the relationship between perceived infectiousness and depression, even when omitting fear from the model. Second, avoidance was a discriminant predictor of depression, as neither pandemic-related checking and reassurance-seeking nor cleaning behavior mediated the relationship between cognition and depressive symptoms. Clinical implications are discussed, including how addressing the relationship between anxiety about viral infections and depression can prospectively increase treatment success as we move beyond the pandemic.

A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity

Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments' potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT's psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument's reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.

Feedback negativity and feedback-related P3 in individuals at risk for depression: Comparing surface potentials and current source densities

Blunted responses to reward feedback have been linked to major depressive disorder (MDD) and depression risk. Using a monetary incentive delay task (win, loss, break-even), we investigated the impact of family risk for depression and lifetime history of MDD and anxiety disorder with 72-channel electroencephalograms (EEG) recorded from 29 high-risk and 32 low-risk individuals (15-58 years, 30 male). Linked-mastoid surface potentials (ERPs) and their corresponding reference-free current source densities (CSDs) were quantified by temporal principal components analysis (PCA). Each PCA solution revealed a midfrontal feedback negativity (FN; peak around 310 ms) and a posterior feedback-P3 (fb-P3; 380 ms) as two distinct reward processing stages. Unbiased permutation tests and multilevel modeling of component scores revealed greater FN to loss than win and neutral for all stratification groups, confirming FN sensitivity to valence. Likewise, all groups had greater fb-P3 to win and loss than neutral, confirming that fb-P3 indexes motivational salience and allocation of attention. By contrast, group effects were subtle, dependent on data transformation (ERP, CSD), and did not confirm reduced FN or fb-P3 for at-risk individuals. Instead, CSD-based fb-P3 was overall reduced in individuals with than without MDD history, whereas ERP-based fb-P3 was greater for high-risk individuals than for low-risk individuals for monetary, but not neutral outcomes. While the present findings do not support blunted reward processing in depression and depression risk, our side-by-side comparison underscores how the EEG reference choice affects the characterization of subtle group differences, strongly advocating the use of reference-free techniques.

Weight bias internalization is positively associated with insomnia symptom severity in young women with disordered eating

OBJECTIVE

Social stigma has been associated with disparities in sleep heath; however, one type of stigma that has been less evaluated is weight bias internalization. Previous studies have shown inconsistent results linking weight bias internalization and sleep problems and few have examined associations with insomnia.

METHODS

Women with disordered eating (N = 173, Mage=20.22, SD=1.70, range=18-25) completed questionnaires measuring insomnia symptoms, weight bias internalization, alcohol use, and dysphoria. Linear regression tested associations between weight bias internalization and insomnia symptom severity, after adjusting for demographic variables, alcohol use, and dysphoria.

RESULTS

Weight bias internalization, alcohol use, and dysphoria were significantly positively associated with insomnia symptom severity above-and-beyond demographic variables.

CONCLUSIONS

Although effect sizes were small, weight bias internalization was associated with greater insomnia symptom severity. Results add to the growing literature examining the associations of stigma with sleep health.

Just as Essential: The Mental Health of Educators During the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic deleteriously impacted physical and mental health. In the summer of 2020, return-to-learn plans were enacted, including virtual, hybrid, and in-person plans, impacting educators and students. We examined (1) how return-to-learn plan was related to depressive and social anxiety symptoms among educators and (2) how psychological flexibility related to symptoms.

METHODS

Educators (N = 853) completed a survey via Qualtrics that assessed internalizing symptoms, psychological flexibility, and occupational characteristics. Two one-way analyses of variance (ANOVAs) examined between-group differences in return-to-learn plans across depression and social anxiety. Two hierarchical linear regressions examined the relation between psychological flexibility components and depressive and social anxiety symptoms.

RESULTS

Median T-scores were well above the national normative means for General Depression (median T-score: 81) and Social Anxiety (median T-score: 67). There were no significant differences between reopening plans in general depression nor social anxiety T-scores. Psychological flexibility accounted for 33% of the variance in depressive symptoms and 24% of the variance in social anxiety symptoms.

CONCLUSIONS

Results indicated high levels of psychiatric symptoms among educators during COVID-19, and psychological flexibility was associated with lower symptoms. Addressing educator mental health is of utmost importance in future research.

Characterizing depression after traumatic brain injury using a symptom-oriented approach

BACKGROUND

Progress in addressing depression after traumatic brain injury (TBI) has been limited. Traditional approaches to measuring depression classify individuals with diverse symptoms as having the same problem. We adopted a novel, symptom-oriented approach to characterize post-TBI depression, emphasizing specific symptoms rather than the number of symptoms.

METHODS

We assessed depressive symptoms cross-sectionally in 393 participants with moderate-severe TBI (range 0.4-35.4 years post-injury; M = 12.6) using the Inventory of Depression and Anxiety Symptoms - Expanded Version (IDAS-II). We analyzed symptoms of DSM-5 major depressive disorder (MDD), separating compound symptoms into sub-symptoms. We quantified depression heterogeneity across 16 specific symptoms and explored associations between each symptom and personal, injury-related, treatment, and functional/psychosocial outcome factors.

RESULTS

28 % of participants self-reported a current depression diagnosis, and 35 % met DSM-5 symptom criteria for MDD. Depressed participants (according to either self-reported diagnosis or MDD symptom criteria) were more likely to endorse each specific depressive symptom, including those that overlap with TBI. Post-TBI depression was highly heterogeneous, with 84-91 % of depressed participants (depending on classification method) showing a unique symptom profile not shared with any other individual. The most common symptom profile was shared by only three individuals. This heterogeneity was meaningful, as specific depressive symptoms had distinct associations with personal, injury-related, treatment, and outcome factors.

LIMITATIONS

Cross-sectional design. We only analyzed DSM-5 MDD symptoms, and some symptoms were assessed using only one item.

CONCLUSIONS

A symptom-oriented approach to post-TBI depression captures the individual's unique profile of depressive symptoms, which relate differently to outcomes and other factors. We recommend future studies investigating post-TBI depression analyze specific symptoms alongside overall depression scores.

Assessment of Depression in Adults and Youth

This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.

Default Mode Network Hypoalignment of Function to Structure Correlates With Depression and Rumination

BACKGROUND

Recent studies have begun to examine how signals in the brain correspond to the underlying white matter structure using tools from the field of graph signal processing to quantify brain function alignment to brain network topology. Here, we applied this framework for the first time toward a transdiagnostic cohort of individuals with internalizing psychopathologies, including mood and anxiety disorders, to uncover how such alignment within the default mode network (DMN) is related to depression and rumination symptoms.

METHODS

Both diffusion-weighted and resting-state functional magnetic resonance imaging were obtained from participants at baseline (n = 60 patients, n = 19 healthy control participants). Patients were randomized to 12 weeks of treatment with either a selective serotonin reuptake inhibitor or cognitive behavioral therapy, and symptom scales were readministered posttreatment (n = 46 patients at follow-up). Using graph signal processing methodology, we quantified the alignment of functional signals to their underlying white matter structural networks.

RESULTS

We found that signal alignment within the posterior DMN was decreased in patients with internalizing psychopathologies compared with healthy control participants and was inversely (negatively) correlated with baseline depression and rumination scales. Signal alignment within the posterior DMN was also correlated with the ratio of total within-DMN to extra-DMN functional connectivity for these regions.

CONCLUSIONS

These findings are consistent with previous literature regarding pathological promiscuity of posterior DMN connectivity and provide the first graph signal processing-based analyses in a transdiagnostic cohort of patients with internalizing psychopathologies.

Associations of antidepressant medication consumption with changes in personality pathology and quality of life among community-dwelling adults

BACKGROUND

Although antidepressant medication (ADM) has produced small advantages over pill placebo in randomized controlled trials, consuming ADM has predicted prospectively increasing depressive symptom severity in samples of community-dwelling adults.

OBJECTIVE

We extended the community literature by testing ADM's relations to changes in personality and quality of life that may underpin depression.

METHOD

In this longitudinal, observational study, community-dwelling adults (N = 601) were assessed twice, 8 months apart on average. Assessments included depressive symptoms, personality, life satisfaction and quality, and prescription medication consumption.

RESULTS

Consuming ADM at time 1 predicted relative increases in depressive symptoms (dysphoria), maladaptive traits (negative affect, negative temperament, disinhibition, low conscientiousness), personality dysfunction (non-coping, self-pathology), and decreases in life satisfaction and quality from time 1 to 2, before and after adjustment for age, gender, race, income, education, physical health problems, and use of other psychotropics. In no analysis did ADM use predict better outcomes.

CONCLUSION

Among community-dwelling adults, ADM use is a risk factor for psychosocial deterioration in domains including depressive symptoms, personality pathology, and quality of life. Until mechanisms connecting ADM to poor outcomes in community samples are understood, additional caution in use of ADM and consideration of empirically supported non-pharmacologic treatments is prudent.

Social feedback biases emerge during recall but not prediction and shift across the development of social anxiety

Memory is a reconstructive process that can result in events being recalled as more positive or negative than they actually were. While positive recall biases may contribute to well-being, negative recall biases may promote internalizing symptoms, such as social anxiety. Adolescence is characterized by increased salience of peers and peak incidence of social anxiety. Symptoms often wax and wane before becoming more intractable during adulthood. Open questions remain regarding how and when biases for social feedback are expressed and how individual differences in biases may contribute to social anxiety across development. Two studies used a social feedback and cued response task to assess biases about being liked or disliked when retrieving memories vs. making predictions. Findings revealed a robust positivity bias about memories for social feedback, regardless of whether memories were true or false. Moreover, memory bias was associated with social anxiety in a developmentally sensitive way. Among adults (study 1), more severe symptoms of social anxiety were associated with a negativity bias. During the transition from adolescence to adulthood (study 2), age strengthened the positivity bias in those with less severe symptoms and strengthened the negativity bias in those with more severe symptoms. These patterns of bias were isolated to perceived memory retrieval and did not generalize to predictions about social feedback. These results provide initial support for a model by which schemas may infiltrate perceptions of memory for past, but not predictions of future, social events, shaping susceptibility for social anxiety, particularly during the transition into adulthood.

The impact of trauma-related symptoms and neuroticism on compensatory behaviors in a sample of adults with eating disorders

INTRODUCTION

Inappropriate compensatory behaviors (ICBs), including purging, restricting, and excessive exercising, are key symptoms of several eating disorders (EDs). Studies have found positive associations between trauma and ICBs, although few studies have explored mechanisms that may explain these relationships. Emotion dysregulation has been posited as a mechanism that explains associations among ICBs and trauma. Given that individuals with high neuroticism may be particularly likely to use ICBs to regulate emotions following a trauma, the purpose of this study was to test whether neuroticism moderated the relationship between trauma-related symptoms and each type of ICB (purging, restricting, and excessive exercise).

METHOD

A community sample of adults with a DSM-5 ED (N = 263; 83.7 % female) completed measures of trauma-related symptoms, ED psychopathology, and personality.

RESULTS

Zero-inflated negative binomial models revealed that trauma-related symptoms alone predicted restricting and purging behavior. In addition, we found that neuroticism alone predicted the presence of excessive exercise. We found no significant interaction between trauma-symptoms and neuroticism.

CONCLUSION

Although past research has documented high rates of co-occurring ED and PTSD, the connections between trauma-related symptoms and ICBs are complex and may be unique to each type of ICB. Given that neuroticism may not influence the relationship between trauma-related symptoms and ICBs, more research should be done to establish an understanding of factors that could explain the relationship between ICBs and trauma-related symptoms. Novel interventions that simultaneously target restricting, purging, and trauma-related symptoms could be beneficial to explore.

Assessing posttraumatic stress disorder symptom clusters with the Minnesota Multiphasic Personality Inventory-3 in a forensic disability sample

OBJECTIVE

Previous evidence indicates that scales from the Minnesota Multiphasic Personality Inventory (MMPI) family of instruments can measure self-reported posttraumatic stress disorder (PTSD) symptomology and differentiate symptom clusters, including in forensic disability assessments. However, limited research has examined assessment of PTSD symptoms with the MMPI-3, the most recent MMPI instrument. The goal of the current study was to identify the strongest MMPI-3 scale predictors of individual PTSD symptom clusters, measured via self-report.

METHODS

Using a sample of 716 disability claimants (54.2% men; Mage  = 42.98, SD = 10.87; 81.8% White), correlation, regression, and dominance analyses were performed to examine associations between scores on MMPI-3 scales and latent PTSD symptom cluster factors derived using confirmatory factor analyses from items of the Detailed Assessment of Posttraumatic Stress (DAPS), and to identify the strongest predictor of each symptom cluster when MMPI-3 scales were concurrently considered.

RESULTS

Results indicate that conceptually expected MMPI-3 scale scores were meaningfully associated with PTSD symptom cluster factors, with the MMPI-3 Anxiety-Related Experiences (ARX) scale demonstrating the strongest and most consistent associations across symptom clusters.

CONCLUSIONS

Results of the current study largely converge with previous empirical studies of self-reported PTSD symptoms in disability claimant settings with the MMPI instruments. Interpretive implications for the MMPI-3, limitations, and future research directions are discussed.

Learning from adversity: What the COVID-19 pandemic can teach us about family resiliency

The present study aimed to characterize the immediate impacts of the COVID-19 pandemic on families with preschool age children and to identify pre-pandemic factors that explained unique family experiences. We leveraged an ongoing longitudinal study of relatively well-resourced community families who had reported on family functioning prior to the pandemic and completed surveys 6 months after pandemic onset. Both parents of dual parenting households endorsed significant hardships as a direct result of the pandemic (e.g., disrupted family routines, challenges at work); however, families also reported aspects of flourishing (i.e., experiencing positive outcomes in response to adversity) such as spending more time together as a family. Families were prone to greater hardships and fewer opportunities for growth to the extent that parents were lower in psychological resources (i.e., greater stress and internalizing symptoms, poor well-being) and were not on the same page as a couple (i.e., interparental discord, low quality coparenting) prior to pandemic onset. Finally, greater pandemic hardships predicted poorer parental mental health, greater family dysfunction, and elevated child psychopathology, controlling for pre-pandemic levels. Parents who reported more family flourishing from the pandemic had a stronger interparental relationship. Results are intended to inform theories of family stress and family interventions that can be tailored to promote resiliency (i.e., adaptation to challenging life events) and prevent dysfunction when families face rapid change and adjustment and high degrees of uncertainty and stress.

Looking beyond time alone: An examination of solitary activities in emerging adulthood

INTRODUCTION

Solitude represents an important context for emerging adults' well-being; but to date, little is known about how emerging adults spend their time alone. The goals of this study were to: (1) describe and characterize solitary activities among emerging adults attending university; (2) examine links between solitary activities and indices of adjustment; and (3) explore the moderating role of affinity for solitude in these associations.

METHODS

Participants were N = 1798 university students aged 18-25 years (Mage  = 19.73, SD = 1.46; 59.7% female) who completed assessments of how/why they spend time alone and indices of psychosocial adjustment (e.g., well-being, psychological distress, loneliness, and aloneliness).

RESULTS

Emerging adults who spent time alone predominantly thinking reported poor adjustment outcomes (i.e., higher loneliness and psychological distress, and lower well-being) and dissatisfaction with solitude, whereas those who engaged in active leisure activities or passive technology use while alone reported lower psychological distress and higher satisfaction with solitude. The negative implications of doing nothing were not attenuated at higher levels of affinity for solitude.

DISCUSSION

These findings suggest that some solitary activities are more beneficial than others.

Disinhibition domain and facets uniquely predict changes in depressive symptoms and psychosocial functioning

This study aimed to understand the role of disinhibition (low conscientiousness)-in conjunction with the other major personality traits of negative affectivity, detachment, antagonism, and psychoticism-in predicting changes in depressive symptoms and psychosocial functioning. Both the disinhibition trait domain and its primary facets (i.e., irresponsibility, impulsivity, and distractibility) were examined. In a large sample (Time 1 N = 605, Time 2 N = 497) of psychiatric outpatients and high-risk community residents, personality traits, depressive symptoms (both self-reported and interviewer-rated), and psychosocial functioning levels (i.e., daily functioning, interpersonal functioning, health-related quality of life, and global quality of life) were collected across two time points. Results showed that the disinhibition domain was the strongest predictor of changes in depressive symptoms and general quality of life levels. Disinhibition facets also predicted changes in depressive symptoms but showed a less consistent pattern compared to the broader trait domain. Finally, the irresponsibility and distractibility facets significantly and uniquely explained changes in interpersonal functioning. The study highlights the importance of assessing the disinhibition trait rather than only negative and positive affectivity (which are well-known correlates of depression), for understanding changes in depressive symptoms and psychosocial functioning. The findings identify potential targets in psychotherapy for individuals with disinhibition traits and depressive disorders.

Helpful activities during the COVID-19 pandemic: Perceived benefits and actual association with psychiatric symptoms and psychological wellbeing

BACKGROUND

Few studies have rigorously examined the effectiveness of commonly reported coping activities during the COVID-19 pandemic. This study was designed to assess perceived helpful activities during the pandemic and to investigate the extent to which these activities were associated with psychological outcomes.

METHOD

Adults living in the US (N = 204), who were part of a longitudinal family study of depression responded to an online survey. They reported on their perceived helpful activities during the pandemic. General linear regression models (GLM) were used to evaluate the association between perceived helpful activities and current psychiatric symptoms, controlling for demographic factors, and pre-pandemic psychiatric history and symptoms.

RESULTS

The top perceived helpful activity during COVID-19 was communicating with friends/family via telephone text or video (75.5 %). However, of the top five activities endorsed, cooking/baking was associated with the most clinical outcomes, including lower anxiety/depression and greater psychological wellbeing (all ps < 0.05). These relationships were most prominent among younger individuals < age 40 years, females, and those with recent psychiatric history, although they extended to younger males, and individuals at high or low depression risk.

LIMITATIONS

Close ended items limited variability in coping activities reported. The study lacked data on substance use. The sample was racially and ethnically homogenous.

CONCLUSIONS

These findings move beyond anecdotal evidence that cooking/baking as a coping activity yields protection against psychopathology. Its ready accessibility and ability to confer benefits across a range of individual characteristics, make it a useful adjunct in therapeutic interventions for people confined to their homes.

The cognitive adaptability and resiliency employment screener (CARES): tool development and testing

Introduction

To decrease psychological risk for content moderators, the study initiated the first steps of developing a robust employment screening tool, namely, the Cognitive Adaptability and Resiliency Employment Screener.

Method

The study consisted of three phases with 4,839 total participants.

Results

In Phase 1, a set of 76 items were developed and tested via exploratory factor analysis, yielding three factors (i.e., Psychological Perseverance & Agility, Rumination & Emotional Lingering, and Expressiveness & Sociability) and also reducing the scale to 68 items. In Phase 2 through confirmatory factor analysis, the three-factor structure showed good fit (CFI = 0.92, RMSEA = 0.05) and demonstrated sufficient overall reliability. In Phase 3, the convergent validity and divergent validity of the tool were established relative to constructs such as resilience, cognitive control and flexibility, emotion regulation, and optimism.

Discussion

Altogether, the findings revealed that the scale demonstrated good psychometric properties that, pending future studies, may serve as a promising employment screener for content moderators.

Effects of the COVID-19 Pandemic on Neural Responses to Reward: A Quasi-experiment

BACKGROUND

The COVID-19 pandemic has been a prolonged period of stress due to social isolation, illness, death, and other major life disruptions. Neural reward sensitivity, essential for healthy functioning, may become reduced under major naturalistic stressors, though few studies have examined this. The present study sought to test whether neural responses to rewards were significantly blunted by the stress of the pandemic.

METHODS

We compared 2 groups of young adult participants, who completed a monetary reward task while an electroencephalogram was recorded, at 2 time points, 1 to 3 years apart. Our measure of reward sensitivity was the reward positivity (RewP), a neural marker enhanced to gain relative to loss feedback. The magnitude of the RewP is sensitive to stress exposure and can prospectively predict depression. The pre-pandemic group (n = 41) completed both time points before the pandemic, while the pandemic group (n = 39) completed the baseline visit before the pandemic and the follow-up visit during its second year.

RESULTS

The pandemic group reported having experienced significant stressors over the course of the pandemic. We did not observe a significant decrease in the RewP from baseline to follow-up in the pre-pandemic group. In contrast, in the pandemic group, the RewP was significantly blunted at the follow-up visit to the extent that it no longer distinguished gain from loss feedback.

CONCLUSIONS

These results suggest that prolonged naturalistic stressors can result in adaptations in neural responses to rewards. Our findings also highlight a possible mechanism linking stress to the development of depression.

Abnormal neurophysiological sensitivity to rewards in depression is moderated by sex and age in middle adulthood

A candidate pathophysiological process in major depressive disorder is diminished neural reactivity to reward delivery, which is theorized to give rise to anhedonia. Reduced amplitude in the reward positivity (RewP), which captures initial reward evaluation, has been linked to current symptoms of depression among child, adolescent, and young adult samples. However, the developmental trajectory of this association is incomplete, with relatively few studies in middle and older adulthood. Further, emerging evidence in the literature also suggests that this association may be linked to female sex-specific processes, but no studies to date have directly contrasted the effect of sex on the depression-RewP association. The current study sought to address these gaps by testing how sex and age may moderate the depression-RewP association within a mature adult community sample. Symptoms of depression were evaluated using a survey and a clinical interview, and the RewP was elicited using a simple guessing task. There was a three-way interaction between depression symptom severity, age, and sex in predicting RewP amplitude. This was driven by younger (late 30's to early 40's) female-sexed people such that for this group, elevated symptoms of depression were associated with blunting of the RewP. This association tapered around age 50. This effect was specific to clinician-rated rather than self-reported depressive symptom severity. This pattern of effects suggests that among female-sexed people, developmental processes continue to shape the association between reward responsiveness and depression throughout middle adulthood.

Individual Differences in Females' Adherence to Public Health Measures and Psychopathology Symptoms During a Global Health Crisis: the Role of Triarchic Psychopathic Traits

The two broad aims of this study were to (a) investigate how the three traits of the triarchic model-boldness, meanness, and disinhibition-relate to compliance with public health measures, as well as to internalizing and externalizing psychopathology, during a public health crisis, and (b) test for associations between psychopathology and compliance with public health measures. Participants were 947 Brazilian adult females aged 18-75 years who completed measures of the triarchic traits, internalizing and externalizing symptoms/problems, and a COVID-19 behaviors and beliefs questionnaire. Multiple regression and path analyses showed meanness to be the only triarchic trait significantly predictive of compliance with public health measures, in a negative direction, when controlling for the other traits. Results also demonstrated that compliance with public health measures was associated with levels of distress (negatively), obsessions/fear (positively), and positive mood (negatively). Overall, the results demonstrate the contributions of the triarchic traits to understanding complex phenomena, highlighting meanness as the most essential triarchic trait predictor of adherence to public health measures among females.

Prenatal negative affectivity and trauma-related distress predict mindful parenting during toddler age: Examining parent-infant bonding as a mechanism

Despite findings demonstrating the importance of parental present-centered awareness, factors undermining mindful parenting have received less attention. Increasingly, evidence points to parental psychopathology as a salient risk factor for parenting difficulties. Thus, the goal of the present study was to investigate specific dimensions of parental trauma-related distress and general negative affectivity during pregnancy as predictors of mindful parenting during toddler age. Parental psychopathology, parent-infant bonding, and mindful parenting were assessed in a sample of heterosexual couples (N = 159) across four waves of data collection spanning pregnancy to child age two. Data were analyzed using path analysis within a dyadic framework. Results demonstrated the unique impact of maternal trauma-related distress during pregnancy (e.g., intrusions and avoidance) on facets of mindful parenting more than two years later. Further, among both mothers and fathers, general negative affectivity common across internalizing disorders undermined mindful parenting through impaired parent-infant bonding. Findings highlight the need for early intervention efforts that incorporate mindfulness strategies to reduce subthreshold symptoms of prenatal psychopathology, promote healthy bonding, and improve parental awareness and self-regulation, thereby enhancing the overall parent-child relationship.

Romanian Inventory of Depression and Anxiety Symptoms (IDAS-II)

Background

The Inventory of Depression and Anxiety Symptoms (IDAS-II) is a self-report measure comprising 99 items divided into 18 non-overlapping scales that allows for a dimensional assessment of depression, anxiety, and bipolar symptoms. The IDAS-II is currently available in English, Turkish, Spanish, German, and Swedish. This study's major goal was to adapt and validate the IDAS-II to the Romanian population.

Method

Participants from a community sample (N = 1,072) completed the IDAS-II (Romanian version) and additional measures assessing depression and anxiety disorders.

Results

Item-level factor analyses validated the unidimensionality of the scales, and internal consistency results indicated that most symptom scales had satisfactory alpha coefficient values. Based on previous structural analyses, a confirmatory factor analysis (CFA) on the IDAS-II scales confirmed a three-component model of "Distress," "Obsessions/Fear," and "Positive Mood." Convergent and discriminant validity were established by correlational analyses with other symptom measures.

Limitations

This study was conducted using a sample from the general population and several of the employed measures have limitations. Specifically, the current study was unable to employ Romanian versions of the gold-standard instruments that assess well-being, obsessive-compulsive disorder, and claustrophobia.

Conclusion

The IDAS-II (Romanian version) is the first clinical measure to assess internalizing dimensions of the Hierarchical Taxonomy of Psychopathology (HiTOP) model that is available for the Romanian population.

Behavioral and brain reactivity to uncertain stress prospectively predicts binge drinking in youth

Prior studies show that individuals with alcohol use disorder exhibit exaggerated behavioral and brain reactivity to uncertain threats (U-threat). It is posited this brain-based factor emerges early in life and contributes to the onset and escalation of alcohol problems. However, no study to date has tested this theory using a longitudinal within-subjects design. Ninety-five young adults, ages 17-19, with minimal alcohol exposure and established risk factors for alcohol use disorder participated in this multi-session study with a 1-year tracking period. Startle eyeblink potentiation and brain activation were collected at separate baseline sessions during the well-validated No-Predictable-Unpredictable (NPU) threat-of-shock task designed to probe reactivity to U-threat and predictable threat (P-threat). Participants self-reported their drinking behavior over the past 90 days at baseline and one-year later. We fit a series of multilevel hurdle models to model the binary outcome of whether binge drinking occurred and the continuous outcome of number of binge drinking episodes. Zero-inflated binary submodels revealed that greater baseline startle reactivity, bilateral anterior insula (AIC) reactivity, and dorsal anterior cingulate cortex (dACC) reactivity to U-threat were associated with increased probability of binge drinking. There were no other associations between reactivity to U- and P-threat and probability of binge drinking and number of binging episodes. These results demonstrate that exaggerated reactivity to U-threat is a brain-based individual difference factor that connotes risk for problem drinking. These findings also add to a growing literature implicating AIC and dACC dysfunction in the pathophysiology of alcohol use disorder.

Psychological distress and treatment preferences among parents amidst the COVID-19 pandemic

The COVID-19 pandemic has presented many stressors for parents. This study was conducted to examine treatment preferences and barriers to care amidst COVID-19. Parents (N ​= ​95) completed self-report measures. Education was provided on interventions (e.g., individual therapy, medication), and acceptability assessed. Elevated stress and distress were observed. Parents indicated interest in services for parenting concerns, stress, anxiety, and depression. Individual therapy and telehealth were highly acceptable, while medication and group therapy were less accepted. Findings highlight the need for specific supports among parents amidst the pandemic. Factors that influence treatment preference warrant further attention. Implications for healthcare service delivery are discussed.

Pre- and Post-Pandemic Religiosity and Mental Health Outcomes: A Prospective Study

Relatively few studies have prospectively examined the effects of known protective factors, such as religion, on pandemic-related outcomes. The aim of this study was to evaluate the pre- and post-pandemic trajectories and psychological effects of religious beliefs and religious attendance. Male and female adults (N = 189) reported their beliefs in religious importance (RI) and their religious attendance (RA) both before (T1) and after (T2) the pandemic's onset. Descriptive and regression analyses were used to track RI and RA from T1 to T2 and to test their effects on psychological outcomes at T1 and T2. The participants who reported a decrease in religious importance and attendance were greater in number than those who reported an increase, with RI (36.5% vs. 5.3%) and RA (34.4% vs. 4.8%). The individuals with decreased RI were less likely to know someone who had died from COVID-19 (O.R. =0.4, p = 0.027). The T1 RI predicted overall social adjustment (p < 0.05) and lower suicidal ideation (p = 0.05). The T2 RI was associated with lower suicidal ideation (p < 0.05). The online RA (T2) was associated with lower depression (p < 0.05) and lower anxiety (p < 0.05). Further research is needed to evaluate the mechanisms driving decreases in religiosity during pandemics. Religious beliefs and online religious attendance were beneficial during the pandemic, which bodes well for the use of telemedicine in therapeutic approaches.

Investigating False Memory and Illusory Pattern Perception Bias in Schizophrenia Patients with and without Delusions

Background

Whether the false memory dysfunction in schizophrenia is at the early (encoding, perceptual) or later (retrieval) stages and how delusions affect it remains unclear.

Method

In this study, we examined the perception and memory biases in schizophrenia patients with (Sch/D; n = 31) and without delusions (Sch/Nd; n = 32) and compared them with healthy controls (HCs; n = 35). We used the Deese Roediger McDermott (DRM) Paradigm and the Noise Task to measure the false memory and illusory pattern perception (IPP) biases, respectively.

Results

We found that the patient groups performed lower in both the recall and recognition phases for the DRM and the Noise tasks and made more errors compared to the HC group. Additionally, the performance of the Sch/D group was remarkably lower than the Sch/Nd and HC groups.

Conclusions

Our results indicated that the information-processing problem in schizophrenia exists in both the encoding and retrieval stages. Also found significant relationship between the presence of delusions and the increase in cognitive deficits.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10393-6.

Parent mental health and child behavior during the COVID-19 pandemic

Objective

Child behavior, which encompasses both internalizing and externalizing behaviors, is associated with many outcomes, including concurrent and future mental health, academic success, and social well-being. Thus, understanding sources of variability in child behavior is crucial for developing strategies aimed at equipping children with necessary resources. Parental mental health (PMH) difficulties and preterm birth may be risk factors for child behavior (CB) problems. Moreover, not only are PMH difficulties more common among parents of preterm children, but preterm children might also be more sensitive than full-term children to environmental stressors. In this study, we examined how PMH and CB changed during the COVID-19 pandemic, how change in PMH related to change in CB, and whether preterm children were more susceptible than full-term children to change in PMH.

Methods

Parents that participated in a study prior to the pandemic were invited to complete follow-up questionnaires during the pandemic about PMH and CB. Forty-eight parents completed follow-up questionnaires.

Results

Our results suggested that parental depression symptoms, children's internalizing symptoms, and children's externalizing symptoms significantly increased, and parental well-being significantly decreased during the pandemic. Change in parental depression symptoms, but not change in parental anxiety symptoms or parental well-being, was associated with change in children's internalizing and externalizing symptoms. Prematurity did not moderate change in PMH, change in CB, or the effect of change in PMH on change in CB.

Conclusion

Our findings have the potential to inform efforts aimed at equipping children with behavioral resources.

Self-objectification during the perinatal period: The role of body surveillance in maternal and infant wellbeing

Pregnancy represents a unique time during which women's bodies undergo significant physical changes (e.g., expanding belly, larger breasts, weight gain) that can elicit increased objectification. Experiences of objectification set the stage for women to view themselves as sexual objects (i.e., self-objectification) and is associated with adverse mental health outcomes. Although women may experience heightened self-objectification and behavioral consequences (such as body surveillance) due to the objectification of pregnant bodies in Western cultures, there are remarkably few studies examining objectification theory among women during the perinatal period. The present study investigated the impact of body surveillance, a consequence of self-objectification, on maternal mental health, mother-infant bonding, and infant socioemotional outcomes in a sample of 159 women navigating pregnancy and postpartum. Utilizing a serial mediation model, we found that mothers who endorsed higher levels of body surveillance during pregnancy reported more depressive symptoms and body dissatisfaction, which were associated with greater impairments in mother-infant bonding following childbirth and more infant socioemotional dysfunction at 1-year postpartum. Maternal prenatal depressive symptoms emerged as a unique mechanism through which body surveillance predicted bonding impairments and subsequent infant outcomes. Results highlight the critical need for early intervention efforts that not only target general depression, but also promote body functionality and acceptance over the Western "thin ideal" of attractiveness among expecting mothers.

A Randomized Controlled Trial of Listening Visits for Mothers of Hospitalized Newborns

BACKGROUND

Emotional distress is frequently experienced by mothers whose newborns are hospitalized in a neonatal intensive care unit (NICU). Among these women, there is a critical need for emotional support conveniently delivered at the newborn's point of care by a trusted and medically knowledgeable professional: a NICU nurse. One promising way to enhance in situ delivery of emotional care is to have a NICU nurse provide Listening Visits (LVs), a brief support intervention developed expressly for delivery by nurses to depressed postpartum women.

OBJECTIVES

This trial assessed the feasibility of having NICU nurses deliver LVs to emotionally distressed mothers of hospitalized newborns and compared depression outcomes in a small sample of participants randomized to LVs or usual care (UC).

METHODS

In this pilot randomized controlled trial, emotionally distressed mothers of hospitalized newborns were randomized to receive up to six LVs from a NICU nurse or UC from a NICU social worker. To assess change in depression symptoms, women were invited to complete the Inventory of Depression and Anxiety Symptoms-General Depression Scale at enrollment and 4 and 8 weeks post-enrollment.

RESULTS

Depression symptoms declined over time for both groups, with no difference between the two groups. A post hoc analysis of reliable change found higher rates of improvement at the 4-week assessment among recipients of LVs than UC.

DISCUSSION

NICU nurses successfully implemented LVs during this trial. Depression symptom scores did not significantly differ in the two groups posttreatment or at follow-up. Nevertheless, post hoc analyses indicated comparatively higher rates of clinical improvement immediately after LVs, suggesting the intervention can reduce maternal depression early on when women are most distressed.

Associating broad and clinically defined polygenic scores for depression with depression-related phenotypes

Twin studies indicate that 30-40% of the disease liability for depression can be attributed to genetic differences. Here, we assess the explanatory ability of polygenic scores (PGS) based on broad- (PGS_BD) and clinical- (PGS_MDD) depression summary statistics from the UK Biobank in an independent sample of adults (N = 210; 100% European Ancestry) who were extensively phenotyped for depression and related neurocognitive traits (e.g., rumination, emotion regulation, anhedonia, and resting frontal alpha asymmetry). The UK Biobank-derived PGS_BD had small associations with MDD, depression severity, anhedonia, cognitive reappraisal, brooding, and suicidal ideation but only the association with suicidal ideation remained statistically significant after correcting for multiple comparisons. Similarly small associations were observed for the PGS_MDD but none remained significant after correcting for multiple comparisons. These findings provide important initial guidance about the expected effect sizes between current UKB PGSs for depression and depression-related neurocognitive phenotypes.

The Placement of Obsessive-Compulsive Symptoms Within a Five-Factor Model of Maladaptive Personality

Dimensional models of obsessive-compulsive (OC) symptoms, as seen in obsessive-compulsive disorder (OCD), are instrumental in explaining the heterogeneity observed in this condition and for informing cutting-edge assessments. Prior structural work in this area finds that OC symptoms cross-load under both Negative Affectivity and Psychoticism traits within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model of Personality Disorder (AMPD). However, tests of OC symptoms in conjunction with assessments of the full AMPD structure and its 25 lower-level facets representing narrower symptom content are lacking. We applied joint exploratory factor analysis to an AMPD measure (Personality Inventory for DSM-5; PID-5) and OC symptom data from two separate samples (total N = 1,506) to locate OC symptoms within AMPD space. OC symptoms cross-loaded on Negative Affectivity, Psychoticism, and on the low end of Disinhibition. We also report exploratory analyses of OC symptom subscales with PID-5 variables. Results are discussed in the context OC symptoms' location in PID-5 space, implications for assessment, and placement of OCD within the Hierarchical Taxonomy of Psychopathology.

The effects of the pandemic on mental health in persons with and without a psychiatric history

BACKGROUND

Prospective studies are needed to assess the influence of pre-pandemic risk factors on mental health outcomes following the COVID-19 pandemic. From direct interviews prior to (T1), and then in the same individuals after the pandemic onset (T2), we assessed the influence of personal psychiatric history on changes in symptoms and wellbeing.

METHODS

Two hundred and four (19-69 years/117 female) individuals from a multigenerational family study were followed clinically up to T1. Psychiatric symptom changes (T1-to-T2), their association with lifetime psychiatric history (no, only-past, and recent psychiatric history), and pandemic-specific worries were investigated.

RESULTS

At T2 relative to T1, participants with recent psychopathology (in the last 2 years) had significantly fewer depressive (mean, M = 41.7 v. 47.6) and traumatic symptoms (M = 6.6 v. 8.1, p < 0.001), while those with no and only-past psychiatric history had decreased wellbeing (M = 22.6 v. 25.0, p < 0.01). Three pandemic-related worry factors were identified: Illness/death, Financial, and Social isolation. Individuals with recent psychiatric history had greater Illness/death and Financial worries than the no/only-past groups, but these worries were unrelated to depression at T2. Among individuals with no/only-past history, Illness/death worries predicted increased T2 depression [B = 0.6(0.3), p < 0.05].

CONCLUSIONS

As recent psychiatric history was not associated with increased depression or anxiety during the pandemic, new groups of previously unaffected persons might contribute to the increased pandemic-related depression and anxiety rates reported. These individuals likely represent incident cases that are first detected in primary care and other non-specialty clinical settings. Such settings may be useful for monitoring future illness among newly at-risk individuals.

Neural response to social but not monetary reward predicts increases in depressive symptoms during the COVID-19 pandemic

The prevalence of depressive symptoms has increased during the COVID-19 pandemic, especially among those with greater pandemic-related stress exposure; however, not all individuals exposed to pandemic stress will develop depression. Determining which individuals are vulnerable to depressive symptoms as a result of this stress could lead to an improved understanding of the etiology of depression. This study sought to determine whether neural sensitivity to monetary and/or social reward prospectively predicts depressive symptoms during periods of high stress. 121 participants attended pre-pandemic laboratory visits where they completed monetary and social reward tasks while electroencephalogram was recorded. Subsequently, from March to August 2020, we sent eight questionnaires probing depressive symptoms and exposure to pandemic-related stressors. Using repeated-measures multilevel models, we evaluated whether neural response to social or monetary reward predicted increases in depressive symptoms across the early course of the pandemic. Furthermore, we examined whether neural response to social or monetary reward moderated the association between pandemic-related episodic stressors and depressive symptoms. Pandemic-related stress exposure was strongly associated with depressive symptoms. Additionally, we found that blunted neural response to social but not monetary reward predicted increased depressive symptoms during the pandemic. However, neither neural response to social nor monetary reward moderated the association between episodic stress exposure and depressive symptoms. Our findings indicate that neural response to social reward may be a useful predictor of depressive symptomatology under times of chronic stress, particularly stress with a social dimension.

Risk for trauma-related distress following difficult childbirth: Trajectories of traumatic intrusions across 2 years postpartum

There is heightened risk for maternal posttraumatic stress disorder (PTSD) during the perinatal period. However, it is unclear whether pregnancy and childbirth uniquely contribute to PTSD symptoms above and beyond elevations in negative affectivity that commonly occur among postpartum women (e.g., irritability, fatigue, depressed mood) and past trauma exposure. The present study explored the associations between childbirth stressors and trauma-related distress (TRD; intrusion and avoidance symptoms) across the 2 years following childbirth in a community sample of women (n = 159). Maternal TRD was assessed at pregnancy and four additional timepoints across 2 years postpartum. At pregnancy, mothers completed surveys measuring exposure to trauma and pregnancy-related anxiety. They also reported on pregnancy and childbirth complications across the first 6 months postpartum. Consistent with predictions, labor/delivery complications uniquely predicted increased maternal intrusions during the first 6 months postpartum above and beyond past trauma exposure. Furthermore, growth mixture models identified a subset of women with intrusion symptoms that persisted up to 2 years postpartum and, on average, exceeded the screening threshold for PTSD. Women who experienced greater labor complications were more likely to exhibit this clinical profile relative to low, stable symptoms. Findings highlight the importance of ongoing screening for TRD across the first 2 years postpartum, particularly among women who experience greater labor/delivery complications.