Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants

Hallways Feel Like Homelessness: The Geriatric Boarder Experience

BACKGROUND

Boarding in the Emergency Department (ED) is associated with increased delirium, morbidity, and mortality. Geriatric patients are especially vulnerable to these harms and are more likely to board for a prolonged time. Although multiple studies have investigated clinical outcomes for older adults, we present the first study examining the subjective experience of geriatric boarders through qualitative methods.

METHODS

We conducted semi-structured interviews between June 2024 and July 2024 at a large urban academic hospital. We recruited patients over the age of 65 boarding in the ED for over four hours after an inpatient bed request. Patients were located in hallway care spaces, ED rooms, or in a dedicated unit for ED boarding patients. Interviews were transcribed, coded, and discussed for themes using grounded theory. We halted interviews when we reached thematic saturation.

RESULTS

We recruited 26 participants (mean age 77). Four themes emerged: (1) Care space location matters, and border units are far preferable to hallways, (2) patients were able to compartmentalize the kindness of the hospital staff and quality of medical care from their environment, (3) boarding elicits feelings of powerlessness, and (4) older adults felt acuity of condition and dementia or frailty, rather than age, should determine who should be prioritized for an inpatient room.

CONCLUSION

Our sample of older adults felt stressed and powerless while boarding. They especially struggled in hallway care spaces and preferred dedicated units for boarding. They felt comorbidities and acuity of condition should determine prioritization for inpatient beds rather than age. These insights can help guide health systems how to improve the boarding experience for geriatric patients. More research is needed to understand the older adult's experience boarding in the ED and how to improve it.

[The lasting scars of early emotional deprivation: A study of the current mental health of former Wochenkrippenkinder (children in day and night nursery care) from East Germany]

The care of young children in institutions is typically linked to deprivation, which can negatively impact their psychological development into young adulthood. However, it remains unclear whether early experiences of deprivation also affect psychological well-being in middle and late adulthood. The East German (GDR) weekly nurseries (Wochenkrippen), in which young children and infants were cared for continuously day and night from Monday to Friday, can serve as a testbed for investigating possible long-term psychological consequences of early emotional deprivation.The study examined n=324 former Wochenkrippenkinder (children in weekly nursery care; WK, mean age=55.2 years; 76.9% female) regarding their mental health using self-report questionnaires. In addition, two control groups of former GDR citizens were assessed, a) n=89 participants who experienced day nursery care (TK) and b) n=97 participants who experienced family care only during the first three years of life (FM). A subsample (WK: n=49, TK: n=35, FM: n=44) was examined using a structured clinical interview for mental disorders (Mini-DIPS).The WK group was associated with higher scores across all outcome measures (PHQ-4, CID-S, PSS-10), even after controlling for sociodemographic variables. Regarding the Mini-DIPS, 91.8% of the WK sample met the criteria for at least one diagnosis throughout their lifetime, compared to 60.0% (TK) and 59.1% (FM). Lifetime diagnoses of social anxiety disorder, depressive disorder, and post-traumatic stress disorder were particularly common in the WK sample.Participants who experienced weekly (day and night) nursery care report a markedly higher level of burden concerning various aspects of mental health compared to participants who experienced only day nursery care and participants from exclusive family care. A possible bias due to the self-selection of study participants might limit the generalizability of the results.The results add to the current state of research on the long-lasting detrimental consequences of residential care in early childhood. In the medical history of patients with East German upbringing, special attention should be given to the assessment of possible institutional care in the first years of life.

Effective Recruitment or Bot Attack? The Challenge of Internet-Based Research Surveys and Recommendations to Reduce Risk and Improve Robustness

Internet-based research has exploded in popularity in recent years, enabling researchers to offer both investigations and interventions to broader participant populations than ever before. However, challenges associated with internet-based research have also increased-notably, difficulties verifying participant data and deliberate data manipulation by bot and spam responses. This study presents a viewpoint based on 2 case studies where internet-based research was affected by bot and spam attacks. We aim to share the learnings from these experiences with recommendations for future research practice that may reduce the likelihood or impact of future attacks. The screening and verification processes used are presented and discussed, including the limitations of these. Based on our experience, security and screening within internet-based research platforms are partly effective, but no solution is available to protect researchers completely against bot attacks. Implications for future research and advice for health researchers are discussed.

Bias recognition and mitigation strategies in artificial intelligence healthcare applications

Artificial intelligence (AI) is delivering value across all aspects of clinical practice. However, bias may exacerbate healthcare disparities. This review examines the origins of bias in healthcare AI, strategies for mitigation, and responsibilities of relevant stakeholders towards achieving fair and equitable use. We highlight the importance of systematically identifying bias and engaging relevant mitigation activities throughout the AI model lifecycle, from model conception through to deployment and longitudinal surveillance.

A Screening Measure of Emotion Regulation Difficulties: Polish Norms and Psychometrics of the Difficulties in Emotion Regulation Scale-8 (DERS-8)

Background/Objectives: Difficulties in emotion regulation (DER) serve as a transdiagnostic risk factor for a wide range of emotion-based psychopathologies, including anxiety and depression disorders. This study presents a report on the psychometrics of the eight-item Difficulties in Emotion Regulation Scale-8 (DERS-8) and the development of its Polish norms. Methods: The sample comprised 1329 Polish adults aged 18-73, with 907 females, 384 males, 36 non-binary, and 2 people with an unidentifiable gender. The participants filled out a series of self-report questionnaires on DER, anxiety and depression symptoms, and well-being. Factor structure and measurement invariance, as well as discriminant validity of the DERS-8, were tested with confirmatory factor analysis. Convergent and divergent validity was assessed via relationships with negative and positive mental health outcomes. Internal consistency reliability was evaluated with alpha and omega coefficients. Demographic differences were also examined. Results: Our empirical evidence supported the strong psychometrics of the Polish DERS-8, including its good level of internal consistency reliability (i.e., 0.89) and strong validity. The one-factor DERS-8 model had a good fit, with its supported scalar invariance between a set of demographic variables and levels of mental health outcomes. DERS-8 scores were strong positive predictors of anxiety and depression symptoms and negative predictors of well-being, emphasizing the potential detrimental effects of DER on the dual continuum of mental health and mental illness. Conclusions: The Polish DERS-8 has strong psychometric properties. Given the development of its percentile rank norms, the scale can be used as a good screening measure of DER in the Polish adult sample.

The Impact of Clinical Supervision on the Mental Health Nursing Workforce: A Scoping Review

Clinical supervision is a psychologically safe practice that aims to provide support and training for workers within the healthcare industry, including mental health nurses. Over the years, clinical supervision has been cited as a practice to improve workforce outcomes for both individual mental health nurses and the organisations they work in. The aim of this scoping review is to examine the evidence exploring the relationship between clinical supervision and workforce outcomes for mental health nurses. Twenty-eight articles sourced from six databases were included in this study. The most frequently evaluated workforce outcomes were competence (n = 14), workplace culture (n = 13) and compassion (n = 7). Studies reported that the association between clinical supervision and workforce outcomes was predominantly positive, but there were mixed results for competence, workplace culture, job satisfaction and burnout. Details on the type of clinical supervision received by participants were limited, and most of the evidence included in this review included qualitative research and participants self-reporting their perceived benefits from clinical supervision, as opposed to using validated instruments in experimental and/or longitudinal study designs. Organisations should be hesitant to implement mandatory clinical supervision within workplaces, as this could have the opposite effect on workforce outcomes for mental health nurses who are already time-poor and overworked, as well as those who are indifferent or hostile to clinical supervision.

Integrating general practitioners' and patients' perspectives in the development of a digital tool supporting primary care for older patients with multimorbidity: a focus group study

Introduction

The web application gp-multitool.de is based on the German clinical practice guideline "multimorbidity" and supports mutual prioritisation of treatments by GPs (general practitioners) and patients. The application facilitates sending hyperlinks to standardized assessments by email, which can be completed by patients on any suitable digital device. GPs can document clinical decisions. The tool also supports a structured medication review. Aims of this study were to consider needs and wants of the target groups in implementing the "multimorbidity" clinical practice guideline in a digital tool, and to examine themes of discussions in order to identify which aspects were considered most important for customising a digital tool.

Materials and methods

We conducted six focus groups with 32 GPs and six focus groups with 33 patients. Eight groups were conducted alongside the programming of the web application and four after finishing a prototype. GPs were recruited by mail and asked to invite up to six eligible patients from their practice to participate. Focus groups were based on semi-structured interview guides and discussed assessments, functionalities, usability and reliability of gp-multitool.de. Discussions were transcribed verbatim and analysed using content analysis.

Results

GPs wanted to avoid unnecessary and time-consuming functions and did not want to explore problems that they could not provide solutions for. For some assessments, GPs suggested simplifying scales or including residual categories. GPs and patients also addressed possible misunderstandings due to wording and discussed if some items might be too intimate or overtax patients intellectually. In most cases, participants confirmed usability, but they suggested changes in default settings and pointed out a few minor bugs that needed to be fixed. While some GPs considered data security an important topic, most patients were unconcerned with this issue and open to share their data.

Conclusion

Our study indicates that focus groups can be used to customize a digital tool according to the needs and wants of target groups and thus, improve content, functionality, usability, and reliability of digital tools. However, digital tools still need to be piloted and evaluated in everyday care. In our focus groups, study participants confirmed that gp-multitool.de can be a relevant approach for overcoming deficits in the information needed for mutual prioritisation of treatments by GPs and patients.

"That Came Back to Haunt Me": Violence Against Women Survivors' Concerns About Police Use of Body-Worn Cameras

Despite the substantial contact police have with survivors of violence against women, empirical accounts of survivors' perceptions of police use of body-worn cameras (BWCs) are limited. This study examines survivors' concerns with BWCs. We present qualitative data from semi-structured interviews with 33 survivors of intimate partner abuse and sexual assault. While the majority (79%, n = 26) of the women in this study support police use of BWCs, most (90%, n = 30) still express concerns with the technology. Survivors' concerns fell into three main areas: fear of BWCs capturing trauma responses that could be used against survivors, BWCs decreasing survivor comfort and reporting, and BWCs revictimizing survivors and contributing to survivors' loss of control. The findings reveal concerns that police can work to address to avoid survivor-police relations being deteriorated by police use of BWCs.

A cross-sectional examination of the relationship between learning environment and anxiety among dental hygiene students

OBJECTIVE

This study's purpose was to determine if the learning environment impacts student anxiety in a dental hygiene program by evaluating the two main learning environments: the dental clinic and the traditional classroom. This study also examined educational tasks and their association with anxiety in each learning environment.

METHODS

A web-based survey was conducted using a convenience sample of dental hygiene students enrolled in a two or four year CODA-accredited dental hygiene program in the United States. The Beck Anxiety Inventory was used to determine each participant's anxiety levels in both learning environments. Data analysis included descriptive statistics, correlation, and an analysis of variance.

RESULTS

According to the Beck Anxiety Inventory scoring, dental hygiene students experience a moderate level of anxiety when learning in the dental clinic and a low level of anxiety when learning in the classroom. Nervousness was the most reported anxiety symptom in both the dental clinic and the traditional classroom. Test results from the Spearman correlation show that all dental clinic and classroom educational tasks have a significant correlation (p < 0.01) to a student's anxiety level. Anxiety reported by students did not statistically differ by the year in which they were in the dental hygiene program.

CONCLUSION

Findings suggest anxiety does exist at a moderate level in dental hygiene students. The dental clinic learning environment is associated with greater anxiety among dental hygiene students. Results from this study will be beneficial in understanding how to facilitate student success in a dental hygiene program.

Characteristics of a Successful Nurse Peer Champion in the Implementation of Innovative Digital Technologies in Hospitals: A Qualitative Study

Objectives

Using the Motivational Theory of Role Modelling as a framework, this study explores which attributes nurses deem essential for an effective peer champion, particularly in digital transformation processes within hospitals.

Methods

A qualitative study was conducted with semi-structured interviews. Transcripts were coded using a hybrid approach of inductive and deductive coding and analysed using thematic analysis.

Results

Ten nurses from Germany participated. The attributes most often mentioned were competence, taking on responsibility, a positive and passionate attitude, transferring knowledge and supporting aspirants in applying it, and leadership skills. Four types of champions were identified: a pragmatic and structured champion, a passionate innovator, a social and outgoing team leader, and a calm and empathetic team leader.

Conclusions

The findings largely align with the body of literature on peer champion characteristics in other populations and should therefore be used to guide peer champion application in hospitals to enhance effective implementation of innovations.

Innovation

The identification of four unique champion types offers an innovative contribution to the field. Highlighting the unique requirements of nurses when implementing innovative technologies in healthcare, this study emphasises the importance of involving end-users in the design and implementation process of new technologies, a crucial step towards a more sustainable and user-centred digital health ecosystem.

Epistemic trust and associations with psychopathology: Validation of the German version of the Epistemic Trust, Mistrust and Credulity-Questionnaire (ETMCQ)

Epistemic trust, defined as trust in socially transmitted knowledge, is discussed as a psychopathological factor in the context of new transdiagnostic approaches for the assessment of mental disorders. The aim of this study is to test the factorial, convergent, and discriminant validity of the German version of the new Epistemic Trust, Mistrust and Credulity-Questionnaire (ETMCQ). Data were collected cross-sectionally from the German-speaking general population (N = 584) and in a second sample of clinical (n = 30) and non-clinical (n = 30) participants. The previously proposed three-factor structure of the ETMCQ was analyzed using confirmatory factor analysis. The ETMCQ's ability to differentiate between clinical and non-clinical participants was tested with t-tests. Correlations with early childhood trauma, maladaptive personality traits, and impairments in personality functioning were examined. The relationship between epistemic trust and mentalization was analyzed in a structural equation model. Regarding the factorial validity, the model fit of the originally proposed ETMCQ proved to be insufficient. The model fit to the data was good for a shortened 12-item version. The study was unable to identify any significant differences between clinical and non-clinical participants. For mistrust and credulity, correlations with associated constructs supported their construct validity. However, the results for the trust subscale were heterogeneous. The study offers initial empirical support for a revised 12-item self-report measure of epistemic trust and for the link between mistrust and credulity with markers of psychopathology. Further investigation of the ETMCQ and its psychometric properties, as well as research on integration of epistemic trust into new, transdiagnostic approaches to psychopathology is needed.

Cat Caring Behaviors and Ownership Status of Residents Enrolling a Cat in a Free Sterilization Program

Most cats entering animal shelters in Australia are less than 12 months old and emanate from low socioeconomic areas. Many are unidentified and may be either owned or semi-owned cats (cats cared for by someone who does not consider themselves the owner). In Australia, approximately 33% of cats entering shelters and pounds are euthanized annually, adversely affecting the mental health of staff involved. Our study investigated cat ownership and caregiving behaviors of cats enrolled in the Australian Pet Welfare Foundation's Community Cat Program, which included free sterilization, microchipping, and preventive healthcare. The suburbs targeted in Ipswich, Australia had a high per capita cat intake into animal shelters. We surveyed 1094 cat owners and semi-owners. Most cats were under 12 months old (79%), primarily domestic short-haired (69%), and acquired through informal channels such as friends, family, or as strays. Veterinary care was limited, with only 15% of cats having visited a veterinarian and 28% being vaccinated. Prior to hearing about the free sterilization program, 88.5% of participants identified as owners, while 11.5% were semi-owners. Before completing the survey, these semi-owners transitioned from an informal caregiving relationship to becoming owner of the cat/s. Of the semi-owners, 93% indicated that their transition to ownership was driven by feelings of responsibility, emotional attachment, and access to free sterilization services. These findings suggest that targeted interventions, such as accessible veterinary care and sterilization programs, are crucial in encouraging semi-owners to take full ownership of cats, improving cat welfare, and reducing unplanned breeding. Supporting this transition helps curb overpopulation and fosters improved caregiving, benefiting both cats and communities.

Lessons learnt from the implementation of the Covid-19 vaccination programme in the Southwest of England

BACKGROUND

Vaccination remains one of the most successful public health interventions in preventing severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of people around the world against Covid-19. Most of these programmes have been unprecedented in terms of scale and resources, and have been implemented at times of significant humanitarian crisis. This study aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme. These will help inform emergency preparedness and future crisis management.

METHODS

This qualitative study sought to explore the key drivers to the successful implementation of the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-structured interviews with 75 participants. Document analysis was also used to corroborate the findings emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers for the successful implementation of the programme. The NPT lens was then applied to map the themes identified to the domains and constructs of the framework.

RESULTS

Ten key drivers to the successful implementation of the Covid-19 vaccination programme locally were identified, including: the clarity and consistency of the programme's goal; the diverse representation of stakeholders within the programme leadership team and the mechanisms created by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment; Communication and data specialists' input, and collaboration with local communities to maximise the reach of the programme; and allocating funding to tackle health inequalities.

CONCLUSIONS

This study highlights the lessons learnt from the implementation of the Covid-19 vaccination programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to the needs of individuals, communities and governments.

Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic

Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.

Associations between maternal smartphone use and mother-infant responsiveness: A cluster analysis of potential risk and protective factors

Contradictory results in the extant literature suggests that additional risk factors should be considered when exploring the impacts of maternal smartphone use on mother-infant relationships. This study used cluster analysis to explore whether certain risk factors were implicated in mother-infant dyads with high smartphone use and low mother-infant responsiveness. A cross-sectional survey of 450 participants in the UK measured infant social-emotional development, maternal depressive, anxiety and stress symptoms, wellbeing, social support, smartphone use, and mother-infant responsiveness. Participants were predominantly White (95.3%) and living with a partner (95.2%), with infants who were born full-term (88.9%). Cluster analysis identified three clusters characterized as; cluster (1) "infant at risk" showing high infant development concerns, high maternal smartphone use, and low mother-infant responsiveness; cluster (2) "mother at risk" showing high maternal depressive, anxiety, and stress scores, low social support, high maternal smartphone use, and low mother-infant responsiveness, and cluster (3) "low risk" showing low maternal smartphone use and high mother-infant responsiveness. Significant differences were found between all risk factors, except for maternal smartphone use and mother-infant responsiveness between clusters 1 and 2 suggesting that both clusters require early intervention, although interventions should be tailored towards the different risk factors they are presenting with.

Profiles of theory of mind impairments and personality in clinical and community samples: integrating the alternative DSM-5 model for personality disorders

Introduction

Deficits in theory of mind (ToM)-the ability to infer the mental states of others-have been linked to antagonistic traits in community samples. ToM deficits have also been identified in people with personality disorders (PD), although with conflicting evidence, partly due to the use of categorical diagnoses. The DSM-5 Alternative Model for Personality Disorders (AMPD) provides an opportunity for a more precise understanding of the interplay between ToM abilities and personality pathology. Therefore, the study aims to determine whether and how individuals with diverse ToM profiles differ regarding personality impairment (AMPD Criterion A) and pathological facets (AMPD Criterion B).

Method

Adults with PD (n = 39) and from the community (n = 42) completed tests assessing ToM skills and self-reported questionnaires assessing AMPD Criteria A and B. Hierarchical agglomerative and TwoStep cluster analyses were consecutively computed using scores and subscores from ToM tests as clustering variables. Multivariate analyses of variance were subsequently performed to compare the clusters on both AMPD Criteria. Five clinically and conceptually meaningful clusters were found. The most notable differences across clusters were observed for Intimacy and Empathy dysfunctions (Criterion A), as well as for the Deceitfulness, Callousness, and Hostility facets from the Antagonism domain and the Restricted affectivity facet from the Detachment domain (Criterion B).

Discussion

The results support the association between antagonistic personality facets and ToM deficits. However, clusters showing impairments in ToM abilities did not necessarily exhibit high levels of personality dysfunction or pathological facets, emphasizing that both constructs are not isomorphic. Nevertheless, specific profiles can help refine existing interventions to make them more sensitive and specific to the nature of ToM dysfunctions while considering personality functioning and facets.

How article category in Wikipedia determines the heterogeneity of its editors

Collaboration is essential to advancing knowledge and, ultimately, entire societies. With the development of Web 2.0, the possibilities have risen to unprecedented levels and allowed for the collaborative creation of the world's largest compendium of knowledge that ever existed - Wikipedia. Collaboration is not a safeguard of quality per se, however. Rather, the quality of Wikipedia articles rises with the number of editors per article as well as a greater diversity among them. Here, we address a not yet documented potential threat to those preconditions: self-selection of Wikipedia editors to articles. Specifically, we expected articles with a clear-cut link to a specific country (e.g., about its highest mountain, "national" article category) to attract a larger proportion of editors of that nationality when compared to articles without any specific link to that country (e.g., "gravity", "universal" article category), whereas articles with a link to several countries (e.g., "United Nations", "international" article category) should fall in between. Across several language versions, hundreds of different articles, and hundreds of thousands of editors, we find the expected effect within Wikipedia: The more exclusively an article topic is linked to a particular nation, the higher the proportion of editors from that country is among the contributors.