Prospective trajectories of depression predict mortality in cancer patients

An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.

Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness

OBJECTIVES

Flexibility in self-regulation has emerged as an important component of mental health. Previous findings found that deficits in two components of regulatory flexibility were linked cross-sectionally to psychosis-proneness. We aimed to replicate and extend these findings longitudinally.

METHODS

We measured psychosis-proneness and components of emotion regulation flexibility (i.e. context sensitivity, repertoire and feedback) at two time points with three months in between.

RESULTS

Two flexibility components predicted psychotic-like experiences. The ability to detect the absence of contextual cues was implicated in both positive and negative dimensions but through opposite pathways. Expressive suppression ability-a subcomponent of repertoire-predicted positive symptoms. None of the flexibility components predicted distress related to the symptoms.

CONCLUSIONS

The current study provides further evidence on the implication of emotion regulation flexibility in the longer-term maintenance of psychotic-like experiences. Future studies can advance this work further by evaluating possible bidirectional relationships between psychotic-like experiences and deficits in emotion regulation flexibility.

Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat

Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.

Grief trajectories after loss in pregnancy and during the neonatal period

Distinguishing patterns of grief over time in parents with a loss in pregnancy or during the neonatal period is important for identification of parents with severe grief symptoms, who may need additional support. Our aim was to describe grief in this population and to examine variations by type of loss in a large prospective cohort. We used questionnaire data from the Danish longitudinal cohort, Life After the Loss, which contains information on parents with a loss in pregnancy (from 14 weeks) or during the neonatal period. Parents completed the Prolonged Grief-13 scale at 1, 7, and 13 months after their loss. We applied Latent Growth Mixture Modelling to identify prolonged grief trajectories and used multinomial regression models to assess factors associated with class membership. Three distinct trajectories were identified in 676 parents: resilience (73.1%), recovery (16.9%), and chronic (10%). The distribution varied by type of loss, and the chronic group were overrepresented by parents with stillbirths (16.2%) and neonatal deaths (16.1%) in contrast to parents with spontaneous abortions (8.2%) and termination of pregnancy due to fetal anomalies (6.2%). Furthermore, not having a living child or being a woman was associated with following the chronic trajectory. These results underline that, while most bereaved parents are resilient, 10% experience consistently high levels of grief symptoms during the first year after the loss. Information on type of loss, gender, and whether the parent has living children are meaningful indicators of grief class membership.

Heterogeneous trajectories of depression and resilience following limb amputation

OBJECTIVE

To identify longitudinal trajectories of depression in the first 6 months following limb loss and to explore baseline predictors of trajectories, including pain and demographic factors. A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6 months.

DESIGN

Secondary longitudinal data analysis of an inception cohort study of persons with new-onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months).

SETTING

Hospitalized care, acute rehabilitation, ambulatory care, and community.

PARTICIPANTS

Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4 years (2002-2007). The final sample (n = 203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4 years (standard deviation [SD] = 14.6).

MAIN OUTCOME MEASURE(S)

Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9); posttraumatic stress symptoms were measured via the PTSD checklist- Civilian Version (PCL-C).

RESULTS

Four trajectories of depression were identified via Latent Growth Mixture Modeling: Resilience (73.2%), Chronic Depression (11.2%), Emerging Depression (8.9%), and Recovery (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the Chronic Depression class predicted elevated 6-month PTS compared to all other classes; membership in the Resilience class predicted lower PTS than in the Chronic and Emerging Depression classes but did not differentiate from the Recovery trajectory.

CONCLUSIONS

Findings reveal that the course of depression post-amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as Resilient, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (Emerging Depression), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.

Depressive and anxiety symptom trajectories in Polish adolescents during the COVID-19 pandemic and the outbreak of war in Ukraine: uncovering the role of family relations

INTRODUCTION

The aim of the study was to investigate longitudinal trajectories of change in anxiety and depression symptoms in Polish adolescents during the second year of the COVID-19 pandemic and after the outbreak of the war in Ukraine. Additionally, we aimed to identify risk/protective factors and outcomes associated with these trajectories.

METHOD

We collected data in three waves between November 2021 and May 2022. Adolescents (N = 281 in the first wave) completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Filial Responsibility Scale for Youth, and questions related to the COVID-19 pandemic and war in Ukraine.

RESULTS

We identified three trajectories of depressive symptoms: resilient with low, stable symptoms (71% of participants), chronically elevated symptoms (11%), and acute symptoms followed by recovery (18%). We distinguished two trajectories of anxiety symptoms: resilient (75%) and chronic (25%). Non-resilient trajectories were predicted by higher levels of familial unfairness (perceived lack of equality and reciprocity in the family), relationship difficulties at school and at home, older age, and poor socioeconomic status. Chronic depressive and anxiety symptoms were associated with higher war-related concerns.

DISCUSSION

These findings can inform preventive and therapeutic interventions for at-risk adolescents to reduce negative long-term outcomes of social crises.

Understanding posttraumatic stress trajectories in adolescent females: A strength-based machine learning approach examining risk and protective factors including online behaviors

Heterogeneity in the course of posttraumatic stress symptoms (PTSS) following a major life trauma such as childhood sexual abuse (CSA) can be attributed to numerous contextual factors, psychosocial risk, and family/peer support. The present study investigates a comprehensive set of baseline psychosocial risk and protective factors including online behaviors predicting empirically derived PTSS trajectories over time. Females aged 12-16 years (N = 440); 156 with substantiated CSA; 284 matched comparisons with various self-reported potentially traumatic events (PTEs) were assessed at baseline and then annually for 2 subsequent years. Latent growth mixture modeling (LGMM) was used to derive PTSS trajectories, and least absolute shrinkage and selection operator (LASSO) logistic regression was used to investigate psychosocial predictors including online behaviors of trajectories. LGMM revealed four PTSS trajectories: resilient (52.1%), emerging (9.3%), recovering (19.3%), and chronic (19.4%). Of the 23 predictors considered, nine were retained in the LASSO model discriminating resilient versus chronic trajectories including the absence of CSA and other PTEs, low incidences of exposure to sexual content online, minority ethnicity status, and the presence of additional psychosocial protective factors. Results provide insights into possible intervention targets to promote resilience in adolescence following PTEs.

Identifying multilevel predictors of trajectories of psychopathology and resilience among juvenile offenders: A machine learning approach

Mental ill health is more common among juvenile offenders relative to adolescents in general. Little is known about individual differences in their long-term psychological adaptation and its predictors from multiple aspects of their life. This study aims to identify heterogeneous trajectories of probable psychiatric conditions and their predictors. Participants included 574 juvenile offenders who were first convicted for serious crimes and without detention history. The participants were assessed at 11 timepoints over seven years (2000-2010). Growth mixture modeling revealed the same three trajectories for both probable anxiety and probable depression: stable low trajectory (75.96%; 75.78%), stable high trajectory (15.16%; 10.98%), and recovery (8.89%, 13.24%). Least absolute shrinkage and selection operator (LASSO) logistic regression identified three multilevel predictors for memberships of different trajectories. Risk factors against stable low trajectory lay within personal (e.g., neuroticism), relationship (e.g., parental hostility), and contextual levels (e.g., chaotic neighborhood). Resilience factors for stable low trajectory included strong work orientation and low education level of father. Recovery was predicted by Black race, self-identity, high education level of father, and nonincarcerated sentencing. Our findings suggest that both psychopathology and psychological resilience could be predicted by multiple personal, relationship, and contextual factors in the social ecology of juvenile offenders.

The Flexible Regulation of Emotional Expression Scale for Youth (FREE-Y): Adaptation and Validation Across a Varied Sample of Children and Adolescents

Flexible self-regulation has been shown to be an adaptive ability. This study adapted and validated the adult Flexible Regulation of Emotional Expression (FREE) Scale for use with youth (FREE-Y) in community and maltreatment samples. The FREE-Y measures the ability to flexibly enhance and suppress emotion expression across an array of hypothetical social scenarios. Participants (N = 654, 8-19 years) were included from three studies. Confirmatory factor analysis (CFA) confirmed a theoretically appropriate higher order factor structure. Using multiple-group CFAs, measurement invariance was achieved across maltreatment status, age, and gender. Reliabilities were adequate and construct validity was demonstrated through associations with measures of emotion regulation, psychopathology, IQ, and executive functioning. Group comparisons indicated lower Suppression and Flexibility scores for maltreated versus comparison participants. Findings suggest that the FREE-Y is a valid measure of expressive regulation ability in youth that can be applied across a range of populations.

Looking back and moving forward: dimensions of coping flexibility divergently predict long-term bereavement outcomes

BACKGROUND AND OBJECTIVES

Bereavement is a serious public health concern. Some people suffer prolonged and debilitating functional impairment after the death of a loved one. Evidence suggests that flexibility in coping approaches predicts resilience after stressful life events, but its long-term effects after the unique experience of bereavement are unknown. Which strategies of coping flexibility predict better-or worse-adjustment over time for bereaved people and at what times?

DESIGN AND METHODS

The present study used path analyses to investigate longitudinal effects of forward-focus and loss-focus coping strategies on symptoms of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder in a spousally bereaved adult sample (N = 248) at three time-points after the loss (∼3 months, ∼14 months, and ∼25 months).

RESULTS

Forward-focus coping demonstrated adaptive utility overall, with sooner effects on PCBD than on depression. By contrast, loss-focus coping demonstrated a delayed-onset, maladaptive pattern.

CONCLUSIONS

The findings contribute to the coping flexibility literature by suggesting that the adaptiveness or maladaptiveness of different coping strategies may depend on the context that requires coping. In particular, forward-focus coping may be substantially more advantageous than loss-focus coping in the context of bereavement. Implications, limitations, and future research directions are discussed.

Physical activity may buffer against depression and promote resilience after major life stressors

As many individuals experience potentially traumatic or stressful life events, understanding factors that are likely to promote resilience is imperative. Given the demonstrated efficacy of exercise for depression treatment, we examined if exercise buffers against the risk of developing psychiatric symptoms following life stressors. 1405 participants (61% female) from a longitudinal panel cohort experienced disability onset (43%), bereavement (26%), heart attack (20%), divorce (11%), and job loss (3%). They reported time spent exercising and depressive symptoms (Center for Epidemiologic Studies Depression scale) across three time points collected in two-year intervals: T0 (pre-stressor), T1 (acutely post-stressor), and T2 (post-stressor). Participants were classified in previously identified heterogeneous depression trajectories pre- to post-life stressor: resilient (69%), emerging (11.5%), chronic (10%), and improving (9.5%). Multinomial logistic regression found that more T0 exercise predicted likelihood of classification in resilient versus other groups (all p<.02). Controlling for covariates, only the higher likelihood of classification in resilient versus improving remained (p=.03). Follow-up repeated measures general linear model (GLM) assessed whether trajectory was associated with exercise at each time, controlling for covariates. GLM indicated significant within-subjects effects for time (p=.016, partial η2=.003) and time*trajectory (p=.020, partial η2=.005) on exercise and significant between-subjects effects of trajectory (p<.001, partial η2=.016) and all covariates. The resilient group showed consistent high exercise levels. The improving group had consistent moderate exercise. The emerging and chronic groups were associated with lower exercise post-stressor. Pre-stressor exercise may buffer against depression and ongoing exercise may be associated with lower depression levels following a major life stressor.

Components of emotion regulation flexibility and psychosis: The association between psychosis-proneness and context sensitivity

OBJECTIVES

Emotion regulation flexibility has been conceptualized as a multi-componential construct involving context sensitivity, repertoire and feedback responsiveness. Psychosis research has yet to incorporate these new developments in the study of emotion regulation. Thus, we sought to advance even further the knowledge on emotion regulation in psychosis by adopting the emotion regulation flexibility approach as proposed by Bonanno and Burton (Perspectives on Psychological Science, 2013, 8, 591).

METHOD

In total, 401 participants completed 4 scales assessing the multi-components of emotion regulation flexibility and psychosis-proneness.

RESULTS

Our results indicated that Context Sensitivity (i.e., Cue Absence) and Feedback Responsiveness (i.e., Evaluation) were associated with psychosis-proneness. Cue absence was specifically associated with the positive dimension, while both Cue Absence and Enhancement ability were associated with the negative dimension.

CONCLUSIONS

Overall, our results suggest that emotional context insensitivity is the most relevant component of regulatory flexibility in the case of psychosis-proneness. Thus, the disruption in this first step of flexible emotion regulation might be already present in those prone to psychosis. Difficulties in decoding appropriately the contextual cues might further disrupt the other steps of emotion regulation contributing to the psychotic (-like) experiences. This study needs replication in clinical and non-clinical samples.

The interrelations between psychological outcome trajectories and resource changes amid large-scale disasters: A growth mixture modeling analysis

Currently little is known about the interrelations between changes in psychiatric symptoms and changes in resources (personal, social, financial) amid large-scale disasters. This study investigated trajectories of psychiatric symptoms and their relationships with different patterns of changes in personal, social, and financial resources between 2020 and 2022 amid the COVID-19 pandemic. A population-representative sample (N = 1333) was recruited to complete self-report instruments at the pandemic's acute phase (February-July 2020, T1), and again at 1-year (March-August 2021, T2) and 1.5-year (September 2021-February 2022, T3) follow-ups. Respondents reported depressive and anxiety symptoms, self-efficacy, perceived social support, and financial capacity. Growth mixture modeling (GMM) identified four trajectories of depressive and anxiety symptoms: resilience (72.39-74.19%), recovery (8.40-11.93%), delayed distress (7.20-7.35%), and chronic distress (8.33-10.20%). Four patterns were demonstrated in resource changes: persistent high resources (40.89-47.64%), resource gain (12.08-15.60%), resource loss (6.30-10.43%), and persistent low resources (28.73-36.61%). Loss and gain in financial resources characterized chronic distress and resilience, respectively. Loss in personal resources characterized delayed distress, whereas loss or no gain in social resources was related to chronic/delayed distress. Respondents in resilience were also more likely to have persistent high resources while those with delayed/chronic distress were more likely to have persistent low resources. These results provide an initial evidence base for advancing current understanding on trajectories of resilience and psychopathology in the context of resource changes during and after large-scale disasters.

Everyday life experiences for evaluating post-traumatic stress disorder symptoms

Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms.Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796).Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms.Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = -.427 to -.224, 95% confidence intervals [-.543 to -.359, -.310 to -.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = -.285 to -.096, 95% confidence intervals [-.379 to -.189, -.190 to -.003], p values < .05).Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.

Modular segregation drives causality of the dynamic oscillatory network responses during threat processing

Physiological responses to threat and stress stimuli entrain synchronized neural oscillations among cerebral networks. Network architecture and adaptation may play a critical role in achieving optimal physiological responses, while alteration can lead to mental dysfunction. We reconstructed cortical and sub-cortical source time series from high-density electroencephalography, which were then fed into community architecture analysis. Dynamic alterations were evaluated in terms of flexibility, clustering coefficient and global and local efficiency, as parameters of community allegiance. Transcranial magnetic stimulation was applied over the dorsomedial prefrontal cortex during the time window relevant for physiological threat processing and effective connectivity was computed to test the causality of network dynamics. A theta band-driven community re-organization was evident in key anatomical regions conforming the central executive, salience network and default mode networks during instructed threat processing. Increased network flexibility entrained the physiological responses to threat processing. The effective connectivity analysis showed that information flow differed between theta and alpha bands and were modulated by transcranial magnetic stimulation in salience and default mode networks during threat processing. Theta oscillations drive dynamic community network re-organization during threat processing. Nodal community switches may modulate the directionality of information flow and determine physiological responses relevant to mental health.

Moral injury in human rights advocates

OBJECTIVE

Human rights advocates investigate, document, and combat abuses of individuals and groups around the world and are routinely exposed to events that can be seen as potentially morally injurious. However, few studies have examined the unique risk factors for poor mental health outcomes among this population, and none has explored the impact of moral injury, which is particularly germane given the relevance of this concept arising from the occupational exposure to morally injurious events inherent to human rights work.

METHOD

To address this deficit, we first conducted an exploratory factor analysis on a set of questions about moral injury that had previously been administered to a sample of human rights advocates. Based on this analysis, we modified and reduced these items and identified two constituent subscales. Next, we collected data on a new sample to replicate the factor structure of the reduced scale and to validate the subscales. Finally, we examined the relationship between the two subscales of the reduced moral injury scale and related concepts including posttraumatic stress disorder (PTSD), self-efficacy, and perfectionism in the original sample of human rights advocates.

RESULTS

As predicted, moral injury was associated with PTSD symptom severity and, independently, with self-efficacy and perfectionism.

CONCLUSIONS

The findings add to a growing body of research demonstrating the application of moral injury to civilian populations, particularly those systematically exposed to PMIEs who engage in work to address injustice and violence. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Depression and PTSD in the aftermath of strict COVID-19 lockdowns: a cross-sectional and longitudinal network analysis

Background: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are two highly comorbid psychological outcomes commonly studied in the context of stress and potential trauma. In Hubei, China, of which Wuhan is the capital, residents experienced unprecedented stringent lockdowns in the early months of 2020 when COVID-19 was first reported. The comorbidity between PTSD and MDD has been previously studied using network models, but often limited to cross-sectional data and analysis. Objectives: This study aims to examine the cross-sectional and longitudinal network structures of MDD and PTSD symptoms using both undirected and directed methods. Methods: Using three types of network analysis - cross-sectional undirected network, longitudinal undirected network, and directed acyclic graph (DAG) - we examined the interrelationships between MDD and PTSD symptoms in a sample of Hubei residents assessed in April, June, August, and October 2020. We identified the most central symptoms, the most influential bridge symptoms, and causal links among symptoms. Results: In both cross-sessional and longitudinal networks, the most central depressive symptoms included sadness and depressed mood, whereas the most central PTSD symptoms changed from irritability and hypervigilance at the first wave to difficulty concentrating and avoidance of potential reminders at later waves. Bridge symptoms showed similarities and differences between cross-sessional and longitudinal networks with irritability/anger as the most influential bridge longitudinally. The DAG found feeling blue and intrusive thoughts the gateways to the emergence of other symptoms. Conclusions: Combining cross-sectional and longitudinal analysis, this study elucidated central and bridge symptoms and potential causal pathways among PTSD and depression symptoms. Clinical implications and limitations are discussed.

Associating Flexible Regulation of Emotional Expression With Psychopathological Symptoms

Background: Stressful situations and psychopathology symptoms (e.g., depression and anxiety) shape how individuals regulate and respond to others’ emotions. However, how emotional expressions influence mental health and impact intrapersonal and interpersonal experiences is still unclear.

Objective: Here, we used the Flexible Regulation of Emotional Expression (FREE) scale to explore the relationship between emotional expression abilities with affective symptoms and mental health markers.

Methods: From a sample of 351 participants, we firstly validate a German version of the FREE scale on a final sample of 222 participants located in Germany, recruited through an online platform. Following this, we performed confirmatory factor analyses to assess the model structure of the FREE-scale. We then utilize a LASSO regression to determine which indicators of psychopathology symptoms and mental health are related to emotional expressive regulation and determine their particular interactions through the general linear model.

Results: We replicated the FREE scale’s four latent factors (i.e., ability to enhance and suppress positive as well as negative emotional expressions). After the selection of relevant instruments through LASSO regression, the suppress ability showed specific negative associations with depression (r = 0.2) and stress symptoms (r = 0.16) and positive associations with readiness to confront distressing situations (r = 0.25), self-support (r = 0.2), and tolerance of emotions (r = 0.2). Both, emotional expressions enhance and suppress abilities positively associated with coping markers (resilience) and emotion regulation skills. Finally, the interaction effects between emotional flexibility abilities and stress, depression, and anxiety symptoms evidenced that consistent with the flexibility theory, enhancing and suppressing abilities may predict psychopathological symptoms.

Conclusions: These findings emphasize the importance of considering the flexibility to express emotions as a relevant factor for preserved mental health or the development of psychopathological symptoms and indicate that online surveys may serve as a reliable indicator of mental health.

Expressive flexibility and health-related quality of life: The predictive role of enhancement and suppression abilities and relationships with trait emotional intelligence

This study aims to examine the ability to flexibly enhance and suppress emotional expression, known as expressive flexibility, in relation to physical and psychological health, as well as trait emotional intelligence (EI). A sample of 503 Italian (M_age  = 28.65 ± 9.26 years, 85.1% females) participants completed the Italian version of Flexible Regulation of Emotional Expression (FREE) Scale, the TEIQue-SF, and the Short Form-12 Health Survey. Confirmatory factor analysis indicated that the Italian version of FREE showed adequate psychometric properties. In both genders, results of correlational analyses indicated that enhancement ability was associated with well-being, emotionality, and sociability, whereas suppression ability was associated with self-control. Regression analyses, controlling for age and gender, indicated that suppression and inversely enhancement abilities, predicted the perceived psychological but not physical health. Well-being, self-control, and sociability also contributed to explaining variance in the model. The interaction effect of enhancement and suppression was not significantly associated with either physical or psychological health. Overall, these results suggest that enhancement and suppression abilities differentially contribute to psychological health when trait EI is accounted for. Clinical implications and future directions for research on expressive flexibility are discussed.

Jerome L. Singer (1924-2019)

Memorializes Jerome L. Singer (1924-2019). Singer's seminal research, conducted over 50þ years, laid the foundations for virtually all modern investigations of stream of consciousness and mind wandering. During a time when daydreaming was considered pathological, Singer showed it to be a pervasive aspect of human experience that served positive social and creative functions, earning him the moniker "the father of daydreaming." After receiving his PhD in clinical psychology in 1951, Singer was certified as a psychoanalyst through the William Alanson White Institute, while also holding several part-time research appointments. In 1963, Singer became director of the clinical psychology program at City University, where he and collaborator John Antrobus studied "decoupled attention." Singer joined the faculty of Yale University in 1972 and assumed emeritus status in 2006. At Yale, he worked closely with his wife Dorothy (who was an exemplary developmental psychologist in her own right), where they codirected Yale's Family TV Research and Consultation Center for more than 30 years. He died on December 14, 2019. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Deep learning-based classification of posttraumatic stress disorder and depression following trauma utilizing visual and auditory markers of arousal and mood

BACKGROUND

Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).

METHODS

N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.

RESULTS

Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).

CONCLUSIONS

Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.

[Development of the Italian versions of the FREE Scale and the CSI. Theoretical considerations and preliminary analysis.]

AIM

The Flexible Regulation of Emotional Expression (FREE) Scale assesses the ability to enhance and suppress displayed emotions among a range of hypothetical contexts. The Context Sensitivity Index (CSI) measures the ability to perceive cues to contextual demands across different situations. This study aimed to present the first step of the adaptation and validation to the Italian context of the FREE and the CSI scales.

MATERIALS AND METHODS

A sample of 120 Italian students took part in this first step. Six focus groups were conducted to explore the Context sensitivity, Emotional Flexibility, and Flexible Regulation of Emotional Expression constructs in the Italian context. Verbatim transcripts were analyzed with T-LAB software and two kinds of analyses were performed.

RESULTS

Results of the Thematic Analysis of Elementary Contexts showed four clusters: "emotional flexibility", "emotion management", "emotion regulation", and "context sensitivity". Results of Factorial Analysis of Correspondences indicated three factors with the first two factors explaining about 80% of the variance. Factor 1, which opposed "emotional flexibility" and "context sensitivity" at its negative pole; "emotion management" and "emotion regulation" at its positive pole, was named "Cognitive and emotive functions of mind". Factor 2, which opposed "context sensitivity" and "emotion regulation" on the positive pole, "emotional flexibility" and "emotion management" on the negative pole, was named "Elaboration-adaptation as aim of the subject".

CONCLUSIONS

Preliminary results obtained through a qualitative approach supported the validity of the flexible regulation of emotional expression and the context sensitivity constructs in the Italian context. These results will be tested with a quantitative approach in the next steps of this research.

Social trust and the discounting of gains and losses in prolonged grief

Prolonged grief (PG) is a potentially debilitating consequence of bereavement. Previous studies have associated PG severity with relative deficits in key future-oriented cognitive processes, including the discounting of future rewards. Individual differences in the rate at which one devalues the future have been associated with a range of important economic and health outcomes. To extend understanding of the mechanisms underlying discounting behaviour in PG, this study investigated discounting behaviour using an online paradigm where future consequences were made salient at the time of the decision. Ninety-four bereaved participants made choices to accept or reject offers that involved either an immediate gain and a long-term loss, or an immediate loss and a longer-term gain. Lower levels of social trust and higher PG severity were associated with greater discounting of future losses. Social trust but not PG severity was related to discounting of future gains. Results replicate and extend on previous findings in PG, and suggest potentially modifiable factors to reduce the biases in decision making processes that may contribute to ongoing dysfunction in PG.

Psychopathology and resilience following strict COVID-19 lockdowns in Hubei, China: Examining person- and context-level predictors for longitudinal trajectories

In Hubei, China, where the coronavirus disease (COVID-19) epidemic first emerged, the government has enforced strict quarantine and lockdown measures. Longitudinal studies suggest that the impact of adverse events on psychological adjustment is highly heterogenous. To better understand protective and risk factors that predict longitudinal psychopathology and resilience following strict COVID-19 lockdowns, this study used unsupervised machine learning to identify half-year longitudinal trajectories (April, June, August, and October, 2020) of three mental health outcomes (depression, anxiety, and posttraumatic stress disorder [PTSD]) among a sample of Hubei residents (N = 326), assessed a broad range of person- and context-level predictors, and applied least absolute shrinkage and selection operator (LASSO) logistic regression, a supervised machine learning approach, to select best predictors for trajectory memberships of resilience and chronic psychopathology. Across outcomes, most individuals remained resilient. Models with both person- and context-level predictors showed excellent predictive accuracy, except for models predicting chronic anxiety. The person-level models showed either good or excellent predictive accuracy. The context-level models showed good predictive accuracy for depression trajectories but were only fair in predicting trajectories of anxiety and PTSD. Overall, the most critical person-level predictors were worry, optimism, fear of COVID, and coping flexibility, whereas important context-level predictors included features of stressful life events, community satisfaction, and family support. This study identified clinical patterns of response to COVID-19 lockdowns and used a combination of risk and protective factors to accurately differentiate these patterns. These findings have implications for clinical risk identifications and interventions in the context of potential trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A path to post-trauma resilience: a mediation model of the flexibility sequence

Background: Psychological resilience has grown in popularity as a topic of study in psychotraumatology research; however, this concept remains poorly understood and there are several competing theories of resilience. Objective: This study sought to assess the support for one proposed theory of resilience: the flexibility sequence. Method: This study use secondary data analysis of panel survey data (N = 563). Participants were aged 18 years or over and based in the UK. A series of sequential mediation models was used to test the flexibility sequence theory as a proposed pathway of resilience on mental health outcomes (post-traumatic stress disorder, anxiety, and depression) among a trauma-exposed sample from the UK. Results: The 'feedback' component of the proposed flexibility sequence components was associated with reduced symptom severity with all outcomes, whereas 'context sensitivity' and 'repertoire' were significantly associated only with depression as an outcome. When indirect mediation pathways were modelled via the flexibility sequence, statistically significant effects were observed for all outcomes under investigation. Conclusions: These findings support the theorized flexibility sequence pathway of resilience, suggesting that the combination of these skills/processes performs more favourably as a framework of resilience than any in isolation. Further research into more elaborate associations and feedback loops associated with this pathway is warranted.

Integrative Science Approach to Resilience: The Notre Dame Study of Health & Well-being (NDHWB)

Although many studies have unequivocally demonstrated the promise of understanding resilience to adversity and characterizing the consequences if stress is unabated, needed are dynamic theories and methods to enhance the rigor and interpretation of these assessments. From a dynamic systems perspective, the focus is not whether an individual possesses some fixed ability or unchangeable trait, but rather to understand the flexibility and responsiveness of stress regulation systems to daily hassles and adverse life events. A renewed interest in individual variability allows researchers to see trajectories of change over both short- and long-time scales to understand the developmental course. As a result, it is possible to answer questions, such as, how does the dysregulation in emotion caused by stress, to both within and between daily affect processes, relate to longitudinal trajectories (over time-scales of years) of dysfunction and disease? The overarching goal of the Notre Dame Study of Health & Well-being is to detail the types and qualities of contextual influences, in conjunction with dynamic psychobiological systems, to assess the precursors, concomitant influences and consequences of stress and resilience in the face of adversity on cognitive, health and well-being outcomes.

Trajectories of depression and anxiety during COVID-19 associations with religion, income, and economic difficulties

OBJECTIVE

The current study examined trajectories of anxiety and depression symptoms at three-time points during the COVID-19 pandemic and examined correlates of those trajectories.

DESIGN

Data were collected at three time points during the COVID-19 pandemic.

PARTICIPANTS

The sample in the current study consisted of 804 respondents who had completed the online questionnaire at all three time points designed for the study.

RESULTS

Using Latent Growth Mixture Modeling (LGMM) we identified four trajectories: (a) A resilient group reported consistently low levels of symptoms (62% anxiety and 72% depression), (b) a chronic group reported consistently high levels of symptoms (12% anxiety and 14% depression), (c) an emerging group reported low initial symptoms that increased steadily across time (20% anxiety and 13% depression), and (d) an improving group reported high initial symptoms that decreased across time (6% anxiety and 3% depression).

CONCLUSIONS

The salient conclusion that emerged from these results is that even in a severe and prolonged crisis, such as the COVID-19 pandemic, the most common outcome in the population is that of resilience. Moreover, examining predictors of these trajectories, we found that the resilience trajectory was associated with fewer economic difficulties due to the COVID-19, greater income, and self-identification as religious.

Discriminating Heterogeneous Trajectories of Resilience and Depression After Major Life Stressors Using Polygenic Scores

IMPORTANCE

Major life stressors, such as loss and trauma, increase the risk of depression. It is known that individuals show heterogeneous trajectories of depressive symptoms following major life stressors, including chronic depression, recovery, and resilience. Although common genetic variation has been associated with depression risk, genomic factors that could help discriminate trajectories of risk vs resilience following adversity have not been identified.

OBJECTIVE

To assess the discriminatory accuracy of a deep neural net combining joint information from 21 psychiatric and health-related multiple polygenic scores (PGSs) for discriminating resilience vs other longitudinal symptom trajectories with use of longitudinal, genetically informed data on adults exposed to major life stressors.

DESIGN, SETTING, AND PARTICIPANTS

The Health and Retirement Study is a longitudinal panel cohort study in US citizens older than 50 years, with data being collected once every 2 years between 1992 and 2010. A total of 2071 participants who were of European ancestry with available depressive symptom trajectory information after experiencing an index depressogenic major life stressor were included. Latent growth mixture modeling identified heterogeneous trajectories of depressive symptoms before and after major life stressors, including stable low symptoms (ie, resilience), as well as improving, emergent, and preexisting/chronic symptom patterns. Twenty-one PGSs were examined as factors distinctively associated with these heterogeneous trajectories. Local interpretable model-agnostic explanations were applied to examine PGSs associated with each trajectory. Data were analyzed using the DNN model from June to July 2020.

EXPOSURES

Development of depression and resilience were examined in older adults after a major life stressor, such as bereavement, divorce, and job loss, or major health events, such as myocardial infarction and cancer.

MAIN OUTCOMES AND MEASURES

Discriminatory accuracy of a deep neural net model trained for the multinomial classification of 4 distinct trajectories of depressive symptoms (Center for Epidemiologic Studies-Depression scale) based on 21 PGSs using supervised machine learning.

RESULTS

Of the 2071 participants, 1329 were women (64.2%); mean (SD) age was 55.96 (8.52) years. Of these, 1638 (79.1%) were classified as resilient, 160 (7.75) in recovery (improving), 159 (7.7%) with emerging depression, and 114 (5.5%) with preexisting/chronic depression symptoms. Deep neural nets distinguished these 4 trajectories with high discriminatory accuracy (multiclass micro-average area under the curve, 0.88; 95% CI, 0.87-0.89; multiclass macro-average area under the curve, 0.86; 95% CI, 0.85-0.87). Discriminatory accuracy was highest for preexisting/chronic depression (AUC 0.93), followed by emerging depression (AUC 0.88), recovery (AUC 0.87), resilience (AUC 0.75).

CONCLUSIONS AND RELEVANCE

The results of the longitudinal cohort study suggest that multivariate PGS profiles provide information to accurately distinguish between heterogeneous stress-related risk and resilience phenotypes.

Depression, Anxiety, and Stress Among Healthcare Workers During the COVID-19 Outbreak and Relationships With Expressive Flexibility and Context Sensitivity

This study aimed at investigating depression, anxiety, and stress symptoms among healthcare workers and examine the role of expressive flexibility and context sensitivity as key components of resilience in understanding reported symptoms. We hypothesized a significant and different contribution of resilience components in explaining depression, anxiety, and stress. A total sample of 218 Italian healthcare workers participated in this study through an online survey during the lockdown, consequently to the COVID-19. The Depression Anxiety Stress Scales-21 (DASS-21) was used to measure depression, anxiety, and stress; the Flexible Regulation of Emotional Expression (FREE) scale was used to measure the ability to enhance and suppress emotional expression; the Context Sensitivity Index (CSI) was used to measure the ability to accurately perceive contextual cues and determine cue absence. Demographic and work-related data were also collected. DASS-21 cut-off scores were used to verify the mental status among the respondents. Correlational analyses examined relationships between DASS-21, FREE, and CSI, followed by three regression analyses with depression, anxiety, and stress as dependent variables, controlling for age, gender, and work experience. Enhancement and suppression abilities, cue presence, and cue absence served as independent variables. The results showed a prevalence of moderate to extremely severe symptoms of 8% for depression, 9.8% for anxiety, and 8.9% for stress. Results of correlational analysis highlighted that enhance ability was inversely associated with depression and stress. Suppression ability was inversely associated with depression, anxiety, and stress. The ability to perceive contextual cues was inversely associated with depression and anxiety. The regression analysis showed that the ability to enhance emotional expression was statistically significant to explain depression among healthcare workers. In predicting anxiety, age, and the ability to accurately perceive contextual cues and determine cue absence made substantial contributions as predictors. In the last regression model, age, work experience, and the ability to suppress emotional expression were significant predictors of stress. This study’s findings can help understand the specific contributions of enhancement and suppression abilities and sensitivity to stressor context cues in predicting depression, anxiety, and stress among healthcare workers. Psychological interventions to prevent burnout should consider these relationships.

Expressive flexibility and anxiety

BACKGROUND

The ability to flexibly enhance and suppress emotional expressions plays an important role in emotion regulation and the fostering of social connections. Deficits in expressive flexibility have been linked with posttraumatic stress disorder and prolonged grief reactions. Previous studies have suggested that the ability to respond flexibly in the context of an immediate threat (a nonconscious prime) may be important. In this study we sought to extend this work by examining the impact of individual differences in anxiety on expressive flexibility.

METHODS

Eighty four participants with high and low trait anxiety viewed blocks of negative images with instructions to enhance or suppress emotional expressions. Across blocks one of three nonconscious primes (threat, safety, neutral) appeared before each image. Observers blind to the study's design rated participants' emotional expressiveness.

RESULTS

Repeated Measures Anova's showed that high trait anxiety was associated with lower levels in enhancement ability. Further, low trait anxiety was associated with less emotion in response to the threat prime irrespective of expressive instruction.

LIMITATIONS

This study was cross-sectional which precludes causal relationships. Participants were drawn from a student population and the generalizability to other populations will need to be established CONCLUSIONS: This study identified trait anxiety as factor that may contribute to expressive flexibility deficits. High trait anxiety is a feature of many clinical conditions. Strategies to target expressive flexibility may relevant to a range of anxiety related clinical conditions.

Dispositional Optimism and Context Sensitivity: Psychological Contributors to Frailty Status Among Elderly Outpatients

The association of resilience-related factors with frailty is a recent research topic. Dispositional optimism and context sensitivity are two psychological factors that differently contribute to individual resilience. This study aimed at investigating whether dispositional optimism and context sensitivity might contribute to a multifactorial model of frailty, together with established relevant factors such as cognitive and physical factors. This cross-sectional study involved 141 elderly outpatients (42 males and 99 females) aged ≥65 years, who were referred to the Geriatrics and Multidimensional Evaluation Clinic of the University Hospital of Messina. We used the following measures: the Mini-Mental State Examination (MMSE) to screen for global cognitive functioning; 4-m gait speed and handgrip strength to measure physical performance; a 35-item Frailty Index (FI) to evaluate patients’ frailty status; the revised Life Orientation Test (LOT-R) to gauge dispositional optimism; and the Context Sensitivity Index (CSI) to measure context sensitivity. We found that LOT-R (β = −0.190, p = 0.038), CSI (β = −0.191, p = 0.035), and MMSE (β = −0.466, p < 0.001) were all significantly associated with FI. Gait speed was only marginally associated with FI (β = −0.184, p = 0.053). The present study showed a novel association of dispositional optimism and context sensitivity with frailty among elderly outpatients. These preliminary findings support a multidimensional approach to frailty in which even peculiar psychological features might provide a significant contribution.

Learning to make smart choices in the context of risk: The roles of internal affective feedback and life events

Autonomic arousal may facilitate beneficial decision-making when the link between choices and outcomes is uncertain. However, it is unknown whether greater risk-specific autonomic arousal is linearly associated with faster learning to avoid risky decisions. Furthermore, although the influence of stress on decision-making is well documented, it is unknown whether recent life stress might moderate the relationship between this internal affective feedback and decision-making. We report two studies using the Iowa Gambling Task with diverse community samples. Each study demonstrated a linear relationship between the level of autonomic arousal prior to risky decision-making and the rate of learning to avoid risk. Additionally, participants' recent life events conditionally moderated this association. Specifically, the relationship between risk-specific arousal and advantageous learning was strongest for participants who experienced relatively more positive and fewer negative life events in the previous four months. These findings suggest that autonomic arousal may generally inform decision-making, but less so when life circumstances are relatively poor.

The resilience paradox

Decades of research have consistently shown that the most common outcome following potential trauma is a stable trajectory of healthy functioning, or resilience. However, attempts to predict resilience reveal a paradox: the correlates of resilient outcomes are generally so modest that it is not possible accurately identify who will be resilient to potential trauma and who not. Commonly used resilience questionnaires essentially ignore this paradox by including only a few presumably key predictors. However, these questionnaires show virtually no predictive utility. The opposite approach, capturing as many predictors as possible using multivariate modelling or machine learning, also fails to fully address the paradox. A closer examination of small effects reveals two primary reasons for these predictive failures: situational variability and the cost-benefit tradeoffs inherent in all behavioural responses. Together, these considerations indicate that behavioural adjustment to traumatic stress is an ongoing process that necessitates flexible self-regulation. To that end, recent research and theory on flexible self-regulation in the context of resilience are discussed and next steps are considered.

Anxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique

In the past two decades, climate change-related natural disasters, such as hurricanes, floods, and droughts have become increasingly frequent and severe, impacting the emotional and psychological well-being of those who are directly or indirectly exposed to them. Despite great interest in understanding differences in anxiety and resilience in response to natural disasters, enthusiasm appears to outstrip empirical clarity, as there remains considerable ambiguity as to determinants of resilient or pathological outcomes following exposure to natural disasters. In addition, there are several major methodological limitations in climate change and related natural disaster research, including the use of univariate analyses, cross-sectional design, and retrospective measures. Keeping these limitations in mind, we first review literature examining the mental health outcomes of natural disasters. Findings suggest that, overall, resilience is more common than pathological outcomes. Second, we use a multi-dimensional framework of resilience to selectively review factors at the event, individual, as well as family and community levels that could help inform resilient or pathological outcomes. Finally, we consider key limitations and future directions for research and practice in the field of anxiety and resilience in response to climate disasters.

Are there gender differences in prolonged grief trajectories? A registry-sampled cohort study

Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.

The Suppression Paradox: A Cross-Cultural Comparison of Suppression Frequency, Suppression Ability, and Depression

The habitual use of expressive suppression (suppression frequency) is consistently associated with a number of negative outcomes, but paradoxically, the ability to suppress when there is a situational need (suppression ability) is usually linked to positive outcomes. The two sides of the paradox, suppression frequency and suppression ability, have been found to be unrelated. Given that these findings have emerged in largely western samples, the present studies examined whether the coupling of suppression frequency and ability depends on cultural contexts, and whether this can explain the previously established cultural difference in the costs of suppression frequency. In an initial study, we examined the relations among suppression frequency, suppression ability, and depression in a Chinese sample (Study 1; N = 310), and then, using two new samples, we compared these relations between Chinese and the US samples (Study 2; N = 392). Results showed that suppression frequency was related to depression in two distinct ways. In both cultures, suppression frequency had a direct, positive association with depression. In Chinese culture only, however, suppression frequency also had an indirect association, such that higher suppression frequency was related to higher suppression ability and in turn related to fewer depressive symptoms. Our findings show that suppression frequency is related to suppression ability only among Chinese participants, and can serve as a potential explanation for why suppression frequency is less related to depression in Chinese culture.

IS IT HELPFUL TO HELP OTHERS WHILE GRIEVING?

Introduction: In the current study, we assessed self-reported and behavioral measures of support provided to others and examined their longitudinal relationship to grief and depression symptoms.

Methods: Hierarchical regressions that controlled for initial grief symptoms and support received from others indicated that providing support to others during bereavement had negative effects on psychological functioning, especially for those experiencing high levels of grief at the time of giving.

Results: Across all participants, those who reported providing instrumental support to others at T1 tended to have greater depression symptoms at T2. Furthermore, choosing to donate to bereavement organizations in a laboratory experiment predicted higher levels of grief symptoms at T2, but primarily for participants experiencing high levels of grief at T1.

Conclusion: Additional research is needed to replicate and extend these findings. and determine why helping others during periods of transition and loss may increase one's risk for depression and/or grief.

Psychological adjustment during the global outbreak of COVID-19: A resilience perspective

Amid the global outbreak of COVID-19, resilience is likely to be one of the many possible outcomes. Studies pertaining to resilience following potentially traumatic events including disease outbreak have shown that the vast majority of individuals are resilient, and that outcomes depend on a combination of resilience factors including exposure severity, individual differences, family context, and community characteristics. To better understand psychological dysfunction and resilience during the global outbreak of COVID-19, researchers are encouraged to investigate long-term patterns of mental health rather than cross-sectional prevalence rates, adopt prospective designs and analyses, integrate multiple risk and resilience factors to enhance outcome prediction, and consider the importance of flexibility as the situation unfolds. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Inevitable Loss and Prolonged Grief in Police Work: An Unexplored Topic

The present manuscript presents foundational constructs related to death and loss (i.e., grief, bereavement, prolonged grief) providing empirical findings from recent research on the impact of death and loss on police officers’ health, behavior, and overall functioning. Police officers are routinely exposed to death. In many instances, officers’ contact with decedents includes, among others, victims of accidents, catastrophes, or violent crimes and witnessing the intense emotional suffering of relatives of the deceased. Additionally, it is not uncommon for officers to experience the loss of fellow officers from on-duty deaths and permanent, career-ending injuries. Simultaneously, like everyone, police officers have to cope with deaths of loved ones in their personal lives. The result is that officers’ health and well-being are likely compromised because of the systematic exposure to on- and off-duty deaths. In this perspective paper, death and loss in law enforcement are explored in an attempt to raise awareness and increase attention to this area of police work. In addition, the authors list a number of prophylactic intervention strategies that would support officers cope with the impact of loss and death and promote their own resilience.

Monitoring in emotion regulation: behavioral decisions and neural consequences

Monitoring and deciding how to adjust an active regulatory strategy in order to maximize adaptive outcomes is an integral element of emotion regulation, yet existing evidence remains scarce. Filling this gap, the present study examined core factors that determine behavioral regulatory monitoring decisions and the neuro-affective consequences of these decisions. Using a novel paradigm, the initial implementation of central downregulation strategies (distraction, reappraisal) and the emotional intensity (high, low) were manipulated, prior to making a behavioral decision to maintain the initial implemented strategy or switch from it. Neuro-affective consequences of these behavioral decisions were evaluated using the Late Positive Potential (LPP), an electro-cortical measure of regulatory success. Confirming predictions, initial implementation of reappraisal in high intensity and distraction in low intensity (Strategy × Intensity combinations that were established in prior studies as non-preferred by individuals), resulted in increased behavioral switching frequency. Neurally, we expected and found that in high (but not low) emotional intensity, where distraction was more effective than reappraisal, maintaining distraction (relative to switching to reappraisal) and switching to distraction (relative to maintaining reappraisal) resulted in larger LPP modulation. These findings suggest that monitoring decisions are consistent with previously established regulatory preferences and are associated with adaptive short-term neural consequences.

Understanding the role of regulatory flexibility and context sensitivity in preventing burnout in a palliative home care team

Although burnout syndrome has been investigated in depth, studies specifically focused on palliative home care are still limited. Moreover, there is still a lack of evidence regarding the interplay between emotional flexibility and sensitivity to context in preventing burnout in home care settings. For these reasons, the aims of this study were to examine burnout symptoms among practitioners specializing in palliative home care and to investigate the role of regulatory flexibility and sensitivity to context in understanding burnout. An exploratory cross-sectional design was adopted. A convenience sample (n = 65) of Italian specialist palliative care practitioners participated in this study. Participants were recruited between February and April 2019 from two palliative home care services that predominantly cared for end-of-life cancer patients. The Italian version of the Maslach Burnout Inventory (MBI), the Flexible Regulation of Emotional Expression (FREE) scale (a measure of emotional flexibility), and the Context Sensitivity Index (CSI) (a measure of sensitivity to context) were administered. Analyses of variance were conducted using the three MBI factors as dependent variables and profession as an independent variable. Subsequently, three identical analyses of covariance were conducted with age, work experience, flexibility and sensitivity to context as covariates. The results showed a low burnout risk for all three of the MBI factors, and there were no gender differences. An ANOVA revealed a significant effect of profession type and age on the emotional exhaustion factor of the MBI, and an ANCOVA indicated that these effects persisted after covariates were accounted for. The results also showed a significant effect of the FREE score on emotional exhaustion. These findings can help explain the differential contributions of profession type and age to the burnout symptoms investigated. In addition, the emotional flexibility component, as an aspect of resilience, represents a significant and specific factor of emotional exhaustion. Interventions to prevent burnout must consider these relationships.

Everyday life experiences and mental health among conflict-affected forced migrants: A meta-analysis

BACKGROUND

There are a growing number of forced migrants worldwide. Early detection of poor adjustment and interventions to facilitate positive adaptation within these communities is a critical global public health priority. A growing literature points to challenges within the post-migration context as key determents of poor mental health.

AIMS

The current meta-analysis evaluated the association between daily stressors and poor mental health among these populations.

METHOD

A systematic search in PsycINFO, PubMed, and Web of Science identified relevant studies from inception until the end of 2018. Effect sizes (correlation coefficients) were pooled using Fisher's Z transformation and reported with 95% confidence intervals. Moderator and mediator analyses were conducted. The protocol is available in PROSPERO [CRD42018081207].

RESULTS

Analysis of 59 eligible studies (n = 17,763) revealed that daily stressors were associated with higher psychiatric symptoms (Zr=0.126-0.199, 95% CI=0.084-0.168, 0.151-0.247, p<0.001) and general distress (Zr=0.542, 95% CI=0.332-0.752, p<0.001). Stronger effect sizes were observed for mixed daily stressors relative to subjective, interpersonal, and material daily stressors, and for general distress relative to posttraumatic stress symptoms and general well-being. Effect sizes were also stronger for children and adolescents relative to adults. Daily stressors fully mediated the associations of prior trauma with post-migration anxiety, depressive, and post-traumatic stress disorder symptoms.

CONCLUSIONS

This meta-analysis provides a synthesis of existing research on the role of unfavorable everyday life experiences and their associations with poor mental health among conflict-affected forced migrants. Routine assessment and intervention to reduce daily stressors can prevent and reduce psychiatric morbidity in these populations.

You Can't Take Your Baby Home Yet: A Longitudinal Study of Psychological Symptoms in Mothers of Infants Hospitalized in the NICU

Evidence suggests that mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) experience elevated rates of psychological symptoms. However, previous studies of this population have been mainly cross-sectional and have focused on very preterm infants. Although moderate- to late-preterm infants generally thrive, the possible psychological toll on their mothers has not yet been sufficiently examined. In the current study, we used a longitudinal design to investigate whether mothers of moderate- to late-preterm infants experience elevated rates of psychological symptoms during the infant's hospitalization in the NICU and 6 months later. Results indicated that these mothers did show elevated depression, anxiety, and PTSD symptoms, and that symptom levels were similar in mothers of moderate- versus late-preterm infants. Mothers of moderate- to late-preterm infants hospitalized in the NICU appeared to experience these symptoms steadily over a 6-month period after giving birth. These findings suggest a need for greater support for these mothers while in the NICU.

Trajectories of posttraumatic stress in patients with confirmed and rule-out acute coronary syndrome

Many patients evaluated in the emergency department (ED) for acute coronary syndrome (ACS) develop posttraumatic stress symptoms (PTSS), but little is known about symptom trajectories over time. We estimated longitudinal trajectories of PTSS from ED to 1 year after evaluation for suspected ACS (N = 1000), and the effect of threat perceptions and discharge diagnosis. Participants reported on threat perceptions in the ED, ongoing cardiac threat at 1 month, and PTSS at 1, 6, and 12 months. Latent growth mixture modeling identified 3 PTSS trajectories over 1 year: Resilient (81.75%), Chronic-Worsening (13.69%), and Acute-Recovering (4.56%). Chronic-Worsening and Acute-Recovering classes reported significantly higher ED and cardiac threat perceptions than Resilient class. Discharge diagnosis did not differ (χ²(2) = 2.93, p = .231). PTSS are common following evaluation for suspected ACS, and trajectories vary, but targeting threat perceptions may reduce PTSS and improve clinical course, whether or not patients are ultimately diagnosed with ACS.