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Chen MZ, Chen XL, Xu Q, Cao XD, Wang MY, Cao R. Mediating the Role of Perceived Social Support Between Frailty and Self-Perceived Burden in Elderly Patients with Diabetes. Patient Prefer Adherence 2024; 18:745-752. [PMID: 38558833 PMCID: PMC10979673 DOI: 10.2147/ppa.s452648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To explore the mediating effects of perceived social support between frailty and self-perceived burden (SPB) in elderly patients with diabetes and to provide a theoretical basis for reducing that burden. Methods A total of 169 elderly patients with diabetes who were hospitalised in the endocrinology department of a third-class hospital in Wuxi between May 2020 and July 2022 were included in this study using the convenience sampling method. Patients were assessed by the general information questionnaire, the Chinese version of the Tilburg frailty inventory (TFI), the Self-Perceived Burden Scale (SPBS) and the Perceived Social Support Scale (PSSS). The SPSS 22.0 software was used for Pearson's correlation analysis and multiple linear regression analysis. Model four of the SPSS PROCESS was used for mediating the effect analysis. Results The SPBS of elderly patients with diabetes was positively correlated with the TFI (P < 0.01) and negatively correlated with the PSSS (P < 0.01). The results of the Bootstrap test showed that the mediating effect of the PSSS on the relationship between the TFI and the SPBS in elderly patients with diabetes was 0.296 (95% CI: 0.007, 0.066), and the mesomeric effect accounted for 17.3% of the total effect. Conclusion The debilitation of elderly patients with diabetes can be reduced by decreasing their SPB through perceived social support. This can be achieved through comprehensive interventions by nurses.
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Affiliation(s)
- Ming-Zhu Chen
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital to Nanjing Medical University, Wuxi, 214001, People’s Republic of China
| | - Xiao-Lei Chen
- Nursing Department, The Affiliated Wuxi People’s Hospital to Nanjing Medical University, Wuxi, 214001, People’s Republic of China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
| | - Xiao-Dong Cao
- Nursing Department, The Affiliated Wuxi People’s Hospital to Nanjing Medical University, Wuxi, 214001, People’s Republic of China
| | - Meng-Yu Wang
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital to Nanjing Medical University, Wuxi, 214001, People’s Republic of China
| | - Rong Cao
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital to Nanjing Medical University, Wuxi, 214001, People’s Republic of China
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2
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Jamil B, Su J. Multidimensional social support and associations between COVID-19 stress and depressive/anxiety outcomes among Hispanic/Latinx and White first-year college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-12. [PMID: 38227914 DOI: 10.1080/07448481.2023.2299413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/26/2023] [Indexed: 01/18/2024]
Abstract
Objective: The COVID-19 pandemic has led to greater depression and anxiety among college students. Social support may alleviate this risk. We examined how social support from family, friends, and romantic partners may influence internalizing psychopathology outcomes associated with COVID-19-related stressful events. Participants: Participants were first-years (N = 425, 34.8% Hispanic/Latinx, 74.9% female) enrolled in a United States public university. Methods: Participants completed an online survey in Fall of 2020. Linear regression models examined associations between COVID-19 stressors, social support, depressive and anxiety symptoms, and differences between White and Hispanic/Latinx students. Results: Reported COVID-19 stressors were associated with elevated depressive and anxiety symptoms and higher among Hispanic/Latinx students. Family and friend support were negatively associated with both internalizing outcomes. Partner support was negatively associated with depression and more predictive among White students whereas friend support was for Hispanic/Latinx students' anxiety. Conclusions: These findings demonstrate the importance of social connectedness during the COVID-19 pandemic.
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Affiliation(s)
- Belal Jamil
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Jinni Su
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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3
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Winter A, Gruber M, Thiel K, Flinkenflügel K, Meinert S, Goltermann J, Winter NR, Borgers T, Stein F, Jansen A, Brosch K, Wroblewski A, Thomas-Odenthal F, Usemann P, Straube B, Alexander N, Jamalabadi H, Nenadić I, Bonnekoh LM, Dohm K, Leehr EJ, Opel N, Grotegerd D, Hahn T, van den Heuvel MP, Kircher T, Repple J, Dannlowski U. Shared and distinct structural brain networks related to childhood maltreatment and social support: connectome-based predictive modeling. Mol Psychiatry 2023; 28:4613-4621. [PMID: 37714950 PMCID: PMC10914611 DOI: 10.1038/s41380-023-02252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
Childhood maltreatment (CM) has been associated with changes in structural brain connectivity even in the absence of mental illness. Social support, an important protective factor in the presence of childhood maltreatment, has been positively linked to white matter integrity. However, the shared effects of current social support and CM and their association with structural connectivity remain to be investigated. They might shed new light on the neurobiological basis of the protective mechanism of social support. Using connectome-based predictive modeling (CPM), we analyzed structural connectomes of N = 904 healthy adults derived from diffusion-weighted imaging. CPM predicts phenotypes from structural connectivity through a cross-validation scheme. Distinct and shared networks of white matter tracts predicting childhood trauma questionnaire scores and the social support questionnaire were identified. Additional analyses were applied to assess the stability of the results. CM and social support were predicted significantly from structural connectome data (all rs ≥ 0.119, all ps ≤ 0.016). Edges predicting CM and social support were inversely correlated, i.e., positively correlated with CM and negatively with social support, and vice versa, with a focus on frontal and temporal regions including the insula and superior temporal lobe. CPM reveals the predictive value of the structural connectome for CM and current social support. Both constructs are inversely associated with connectivity strength in several brain tracts. While this underlines the interconnectedness of these experiences, it suggests social support acts as a protective factor following adverse childhood experiences, compensating for brain network alterations. Future longitudinal studies should focus on putative moderating mechanisms buffering these adverse experiences.
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Affiliation(s)
- Alexandra Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Marius Gruber
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Katharina Thiel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Kira Flinkenflügel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Florian Thomas-Odenthal
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Paula Usemann
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Nina Alexander
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Hamidreza Jamalabadi
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Linda M Bonnekoh
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, University of Jena, Jena, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Martijn P van den Heuvel
- Connectome Lab, Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Child Psychiatry, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany.
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Bi Y, Xiao Y, Pan X, Zhang Y, Yang Q, Hu L. Long-term post-traumatic stress symptoms in COVID-19 survivors and its risk factors: a two-year longitudinal cohort study. Psychiatry Res 2023; 329:115523. [PMID: 37812942 DOI: 10.1016/j.psychres.2023.115523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023]
Abstract
The COVID-19 pandemic has led to widespread mental health problems, necessitating the investigation of longitudinal mental health changes, associated risk factors, and neural mechanisms in survivors. We recorded demographics, mental health, social support, and potential exposures in survivors at 3 months (n = 189), 6 months (n = 47), and 2 years (n = 69) post-discharge and collected brain imaging data at the second timepoint. Control groups included non-COVID-19 locals (3 months: n = 188, 6 months: n = 42, 2 years: n = 71). Results indicated that female survivors exhibited higher post-traumatic stress symptoms (PTSS) and depression levels than female controls for up to 2 years, along with higher anxiety level for up to 6 months. Male survivors had higher PTSS, depression, and anxiety levels than male controls at 2 months. Moreover, COVID-related trauma and low social support were risk factors for PTSS and negative emotions in survivors. Neuroimaging revealed increased amygdala activity in male survivors and correlations between hippocampus activity and depression symptoms as well as between right hippocampus activity and social support. Our study emphasized the importance of monitoring mental wellness in COVID-19 survivors and underscored the crucial role of social support in mitigating mental health problems.
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Affiliation(s)
- Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yian Xiao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xinyu Pan
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yuqi Zhang
- Department of Psychology, The University of Hong Kong, Hong Kong, SAR, China
| | - Quanqi Yang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
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Li L, Jiang J, Wu B, Lin J, Roberts N, Sweeney JA, Gong Q, Jia Z. Distinct gray matter abnormalities in children/adolescents and adults with history of childhood maltreatment. Neurosci Biobehav Rev 2023; 153:105376. [PMID: 37643682 DOI: 10.1016/j.neubiorev.2023.105376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
Gray matter (GM) abnormalities have been reported in both adults and children/adolescents with histories of childhood maltreatment (CM). A comparison of effects in youth and adulthood may be informative regarding life-span effects of CM. Voxel-wise meta-analyses of whole-brain voxel-based morphometry studies were conducted in all datasets and age-based subgroups respectively, followed by a quantitative comparison of the subgroups. Thirty VBM studies (31 datasets) were included. The pooled meta-analysis revealed increased GM in left supplementary motor area, and reduced GM in bilateral cingulate/paracingulate gyri, left occipital lobe, and right middle frontal gyrus in maltreated individuals compared to the controls. Maltreatment-exposed youth showed less GM in the cerebellum, and greater GM in bilateral middle cingulate/paracingulate gyri and bilateral visual cortex than maltreated adults. Opposite GM alterations in bilateral middle cingulate/paracingulate gyri were found in maltreatment-exposed adults (decreased) and children/adolescents (increased). Our findings demonstrate different patterns of GM changes in youth closer to maltreatment events than those seen later in life, suggesting detrimental effects of CM on the developmental trajectory of brain structure.
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Affiliation(s)
- Lei Li
- Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jing Jiang
- Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan University, Chengdu, China; Department of Radiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Baolin Wu
- Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jinping Lin
- Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Neil Roberts
- The Queens Medical Research Institute (QMRI), School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
| | - Zhiyun Jia
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan University, Chengdu, China; Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.
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6
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Twait EL, Blom K, Koek HL, Zwartbol MHT, Ghaznawi R, Hendrikse J, Gerritsen L, Geerlings MI. Psychosocial factors and hippocampal subfields: The Medea-7T study. Hum Brain Mapp 2022; 44:1964-1984. [PMID: 36583397 PMCID: PMC9980899 DOI: 10.1002/hbm.26185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
Specific subfields within the hippocampus have shown vulnerability to chronic stress, highlighting the importance of looking regionally within the hippocampus to understand the role of psychosocial factors in the development of neurodegenerative diseases. A systematic review on psychosocial factors and hippocampal subfield volumes was performed and showed inconsistent results, highlighting the need for future studies to explore this relationship. The current study aimed to explore the association of psychosocial factors with hippocampal (subfield) volumes, using high-field 7T MRI. Data were from the Memory Depression and Aging (Medea)-7T study, which included 333 participants without dementia. Hippocampal subfields were automatically segmented from T2-weighted images using ASHS software. Generalized linear models accounting for correlated outcomes were used to assess the association between subfields (i.e., entorhinal cortex, subiculum, Cornu Ammonis [CA]1, CA2, CA3, dentate gyrus, and tail) and each psychosocial factor (i.e., depressive symptoms, anxiety symptoms, childhood maltreatment, recent stressful life events, and social support), adjusted for age, sex, and intracranial volume. Neither depression nor anxiety was associated with specific hippocampal (subfield) volumes. A trend for lower total hippocampal volume was found in those reporting childhood maltreatment, and a trend for higher total hippocampal volume was found in those who experienced a recent stressful life event. Among subfields, low social support was associated with lower volume in the CA3 (B = -0.43, 95% CI: -0.72; -0.15). This study suggests possible differential effects among hippocampal (subfield) volumes and psychosocial factors.
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Affiliation(s)
- Emma L. Twait
- Department of Epidemiology, Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Kim Blom
- Department of Epidemiology, Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Huiberdina L. Koek
- Department of GeriatricsUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Maarten H. T. Zwartbol
- Department of RadiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Rashid Ghaznawi
- Department of RadiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Jeroen Hendrikse
- Department of RadiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Lotte Gerritsen
- Department of PsychologyUtrecht UniversityUtrechtThe Netherlands
| | - Mirjam I. Geerlings
- Department of Epidemiology, Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands,Department of General PracticeAmsterdam UMC, Location University of AmsterdamAmsterdamThe Netherlands,Amsterdam Public Health, Aging & Later life, and Personalized MedicineAmsterdamThe Netherlands,Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and SleepAmsterdamThe Netherlands
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7
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Carcone D, Gardhouse K, Goghari VM, Lee ACH, Ruocco AC. The transdiagnostic relationship of cumulative lifetime stress with memory, the hippocampus, and personality psychopathology. J Psychiatr Res 2022; 155:483-492. [PMID: 36183602 DOI: 10.1016/j.jpsychires.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/19/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Abstract
Stress has a detrimental impact on memory, the hippocampus, and psychological health. Psychopathology research on stress has centered mainly on psychiatric diagnoses rather than symptom dimensions, and less attention has been given to the neurobiological factors through which stress might be translated into psychopathology. The present work investigates the transdiagnostic relationship of cumulative stress with episodic memory and the hippocampus (both structure and function) and explores the extent to which stress mediates the relationship between personality psychopathology and hippocampal size and activation. Cumulative lifetime stress was assessed in a sample of females recruited to vary in stress exposure and severity of personality psychopathology. Fifty-six participants completed subjective and objective tests of episodic memory, a T2-weighted high-resolution magnetic resonance imaging (MRI) scan of the medial-temporal lobe, and functional MRI (fMRI) scanning during a learning and recognition memory task. Higher cumulative stress was significantly related to memory complaints (but not episodic memory performance), lower bilateral hippocampal volume, and greater encoding-related hippocampal activation during the presentation of novel stimuli. Furthermore, cumulative stress significantly mediated the relationship between personality psychopathology and both hippocampal volume and activation, whereas alternative mediation models were not supported. The findings suggest that structural and functional activation differences in the hippocampus observed in case-control studies of psychiatric diagnoses may share cumulative stress as a common factor, which may mediate broadly reported relationships between psychopathology and hippocampal structure and function.
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Affiliation(s)
- Dean Carcone
- Department of Psychological Clinical Science, University of Toronto, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada.
| | - Katherine Gardhouse
- Department of Psychological Clinical Science, University of Toronto, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada; Centre for Addiction and Mental Health (CAMH), 60 White Squirrel Way, Toronto, Ontario, M6J 1H4, Canada
| | - Vina M Goghari
- Department of Psychological Clinical Science, University of Toronto, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada; Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
| | - Andy C H Lee
- Department of Psychological Clinical Science, University of Toronto, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada; Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada; Rotman Research Institute, Baycrest Hospital, 3560 Bathurst St, Toronto, ON, M6A 2E1, Canada
| | - Anthony C Ruocco
- Department of Psychological Clinical Science, University of Toronto, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada; Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
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