Attribution Bias Research Articles

Childhood maltreatment and aggression: The mediating roles of hostile attribution bias and anger rumination

Childhood maltreatment is a recognized risk factor for aggressive behaviours. Although some mediators were found, the mental mechanism underlying the effect of childhood maltreatment on aggression seems to remains unclear. In the present study, a temporal path model (represented by hostile attribution bias (HAB) and anger rumination) was developed to explain the mediating mechanism in the relationship between childhood maltreatment and aggression. The Childhood Trauma Questionnaire, Word-Sentence Association Paradigm-Hostile, Anger Rumination Scale, and Buss-Perry Aggression Questionnaire were used in a sample of 973 undergraduate students. Multiple mediation analysis and bootstrapping were conducted via Mplus7 to assess whether HAB and anger rumination mediated the association between childhood maltreatment and aggression. The results showed HAB (indirect effects = 0.04, 95% confidence intervals [0.03 0.06]) and anger rumination (indirect effects = 0.10, 95% confidence intervals [0.08 0.13]) mediated the link between child maltreatment and aggressive behaviours. Pairwise contrast to the indirect effect indicated that anger rumination had a stronger mediating effect than HAB (p < 0.001). We argue that child maltreatment may trigger immediate aggression during a provoking event through HAB (an in-process mechanism) and lead to delayed aggression after interpersonal conflict through anger rumination (a post-process mechanism).

Mediating Effect of Attributional Biases in the Impulsivity-Aggression Relationship Among Adolescents: Therapeutic Implications.

Aggression is a multidimensional phenomenon, and for its better understanding, specificity involved in its dynamics must be explored. This article explores the role of attributional bias as a mediator between impulsivity and aggressive tendencies among adolescents. The mediating effect of hostile attributional bias (HAB) on the impulsivity-aggression relationship has not been studied extensively so far, especially in the Indian context. For testing the hypotheses, 320 participants within the age range 12 to 15 years (M age = 13.57 years) were selected and administered relevant standardized questionnaires. Baron and Kenny's criterion was used for mediation analysis, demonstrating that HAB partially mediates the association between impulsivity and aggression. Findings imply that reducing HAB through some reattribution intervention may be an effective strategy to reduce impulsivity-induced aggression. Specific guidelines to implement such interventions are suggested in the discussion.

Attributional and attentional bias in children with conduct problems and callous-unemotional traits: a case\u2013control study

BackgroundChildren who are frequently aggressive or lack empathy show various deficits in their social information processing. Several findings suggest that children with conduct problems (CP) show a tendency to interpret ambiguous situations as hostile (hostile attribution bias) and have difficulties to disengage from negative stimuli (attentional bias). The role that additional callous-unemotional traits (CU-traits) play in these biases is yet unclear. Investigating both attentional and attributional aspects of social information processing in children can help us to understand where anomalies in the processing pathway occur and whether the biases are associated with CP and CU-traits separately or in an interactive manner.MethodsWe compared three groups of children: (a) 25 children with CP and low levels of CU-traits (b) 25 children with CP and elevated levels of CU-traits (c) 50 gender (68% male), age (8–17 years) and intelligence score-matched typically developing children, on a pictorial emotional stroop task and a hostile attribution bias task.ResultsIn contrast to our predictions, there were no significant group differences regarding attentional biases or hostile attribution biases. Boys with CP and high levels of CU-traits showed a significantly higher hostile attribution bias compared to girls with CP and high levels of CU-traits. The attention bias to angry stimuli significantly correlated with the hostile attribution bias. Compared to the control group the CP group with low levels of CU-traits showed a significantly stronger association between the attention bias to angry stimuli and the hostile attribution bias.ConclusionsThe current study provides evidence that boys with CP and high levels of CU-traits interpret ambiguous situations as more hostile than girls do. Our results further provide indications that the interaction of attentional and attributional biases in children with CP might contribute to their increased aggressive behavior.

Explications cognitives des hallucinations acoustico-verbales dans la schizophrénie : un article de synthèse de la littérature scientifique

AimsOur article consists in both analysis and synthesis of contemporary cognitive models of auditory verbal hallucinations (AVHs) in schizophrenia. Our work is based on the analysis of the scientific literature including original articles, literature reviews as well as meta-analysis. MethodologyIn order to identify the most pertinent studies in the electronic search, the three following databases were systematically searched: PubMed, PsycINFO and MEDLINE. For both the analysis and synthesis we selected original articles, literature reviews as well as meta-analysis referring to any cognitive explanation of the auditory hallucinatory experience in schizophrenia. A cognitive model of auditory hallucinations refers to any incorporation of cognitive frameworks and explanations in one's conceptualization of the hallucinatory phenomenon in schizophrenia. We also focused our work on past conceptualization of auditory hallucinations in order to explain the development and the contribution of current cognitive models in the understanding of the onset and the maintaining of AVHs. After a brief review of clinical characteristics and historical conceptualization of auditory verbal hallucinations, contemporary explanations were presented in the area of schizophrenia. These explanations referred to researches into cognitive psychopathology including metacognitive as well as neuroimaging studies. ResultsThe examination of scientific literature highlighted the complexity of AVHs through multifactorial explanations here mostly explained by cognitive and metacognitive deficits. We synthesized former conceptualizations of AVHs, which were sustained on mechanistic or sensory explanations. Esquirol, Baillarger and Briere de Boismont were the first as conceiving AVHs as a perception disorder and introduced the idea that auditory hallucinations resulted from a failure to control one's memories/fantasies. Later, Broca and Wernicke discovered auditory areas in the human brain implicated in language comprehension and production. AVHs began to be conceptualized by the scientific world as being mechanistically brain-related. Sigmund Freud was among the first to study the meaning of AVHs, a domain still being investigated by todays cognitive sciences. More recently, neuroimaging studies allowed the validation of these sensory explanations in considering the onset of AVHs through the deficit of cortical and subcortical areas implicated in the process of languages (e.g. Broca and Wernicke areas) and emotions (e.g. limbic system, amygdala, hippocampus). At a more mechanistic level, contemporary cognitive models of AVHs explained AVHs as an intrusive verbal representation into the awareness which is non-inhibited (i.e. deficit in intentional inhibition) and also non-recognized as one's own experience (i.e. deficit in source monitoring, planning and metacognition), or even attributed to an external source (attribution bias). In terms of inhibitory control, inhibition is a basic cognitive mechanism defined as a collection of processes that allows the suppression of previously activated cognitive contents and the clearing of irrelevant actions or attention from consciousness. Intentional inhibition is effortful and occurs when an individual deliberately suppresses the activation of an item after deciding it is irrelevant. Theoretical support for the suggestion that an inhibitory failure is involved in AVHs in schizophrenia arises from studies that have shown that a failure in inhibition results in intrusive thoughts from long-term memory. Recent findings also found that individuals with AVHs in schizophrenia demonstrated an impaired source monitoring. In episodic memory research, a distinction was made between content (an event) and context (e.g. source or temporal characteristics of an event) information. The context of memories provides cues that allow an individual to differentiate one memory from other memories. AVHs are conceptualized as a failure to access the contextual cues that would allow voice-hearer to form an intact representation of events in memories. Regarding planning, AVHs refer to the intrusion of unwanted memories into the inner speech that are not recognized from one's own representation. Previous cognitive theories highlighted the important role played by metacognitive skills and belief (i.e. thinking about one's thinking) in the explanation of AVHs. Finally, the external attribution bias was extensively studied over the last three decades and refers to the tendency to attribute negative events (situational or cognitive) to an external source. In this framework, AVHs refer to intrusive thoughts externally attributed to a voice. ConclusionFor more than one century, scientific discoveries in (bio)medical science have allowed the validation of former sensory and mechanistic explanations of AVHs. Nevertheless, many explanatory models account for the way AVHs are maintained (source monitoring, deficit in planning, externalizing bias), while they scarcely expose how they are triggered (intrusive thoughts, deficit in inhibition). The relation between AVHs and intrusive thoughts still remain unclear, and further studies are needed for the understanding of a potential causal relationship.

Financial strain, maternal attributions, emotion knowledge and children's behavioral readiness for school

In this research, we applied the family stress model to examine maternal hostile attribution bias and emotion situation knowledge as mediators linking family financial strain and children's behavioral readiness for school in a sample of affluent mothers and preschoolers (63 boys). The sample was diverse with regard to race, but the majority of the children were White. Using serial mediational analyses conducted by PROCESS, results indicated that the associations between perceived family financial strain and low levels of social competence and high levels of internalizing behavior were mediated by maternal hostile attributions and lowered child emotion situation knowledge. We discuss the impact of perceived financial strain on parental cognitions and young children's emotion knowledge and behavioral readiness for formal schooling and offer directions for future research and implications for interventions.

Counseling students’ responsibility attributions: Race/ethnicity and trauma narratives

How counseling students conceptualize clients’ presenting concerns, and determine the solutions to those concerns, can negatively impact the effectiveness of the counseling process. Attribution bias damages therapeutic relationships especially when treating racial/ethnic diverse clients or clients with a history of trauma. This study assessed counseling students’ attributions of problem cause and solution for diverse clients and clients with trauma narratives through hypothetical client vignettes. A total of 217 counseling students from counseling programs around the United States participated in the study. Two separate two-way factorial ANOVA’s (CRF-32) were conducted to determine effects of client race/ethnicity and the addition of a trauma narrative on counseling students’ responsibility attributions of problem cause and solution. The interaction between race/ethnicity and trauma narrative was not significant for problem cause or problem solution. The main effect of race/ethnicity was not significant for problem cause or solution. The main effect of trauma narrative was significant for problem cause but was not significant for problem solution. These findings suggest that information from a trauma narrative influences counseling students’ views on their clients’ presenting concerns by increasing their consideration for external factors while mitigating personal blame on the client.

Modification of hostile attribution bias reduces self-reported reactive aggressive behavior in adolescents

Aggressive individuals more readily interpret others’ motives and intentions in ambiguous situations as hostile. This hostile attribution bias has been argued to be causally involved in the development and maintenance of aggression, making it a target for interventions. In our current study, adolescents selected for high levels of aggression (N = 39) were assigned to either a test–retest control group or a five-session hostile attribution bias modification training, in which they were trained to make more benign interpretations of ambiguously provocative social situations. Before and after the training, we assessed hostile attribution bias and both reactive and proactive self-reported aggression in both groups. The training not only tended to produce the expected reduction in hostile attribution bias but also crucially led to decreased levels of reactive but not proactive aggression compared with the control group. Our results thus support the idea that hostile attribution bias can be targeted using training techniques and that such training-induced changes in bias may reduce aggression. However, future studies using an active control group and multiple outcome measures are needed to address the long-term effects of training.

Social cognition and interaction training for recent-onset schizophrenia: A preliminary randomized trial.

Comprehensive social cognition training programs have been effective to improve social cognition in people with chronic schizophrenia, although there is insufficient quality evidence for recent-onset psychosis. The aim of this study was to assess the effects of Social Cognition and Interaction Training (SCIT) in a sample of recent-onset schizophrenia outpatients. Sixteen participants who had their first psychotic episode for less than 2 years were randomly allocated to the SCIT group during 20 weeks (weekly sessions) or to a psychoeducation group and completed baseline and post-training assessment for cognitive biases, social cognition, clinical symptoms and functioning. Permutation-based analysis revealed improvements in overall functioning (P = 0.036) and blame score (P = 0.070) in the SCIT group compared to the psychoeducation intervention, with large effect sizes (d = 1.438 and d = 1.204, respectively). There were also large effect sizes for hostility, emotion recognition, social perception, positive and total symptoms (d = 0.833-1.158). These results suggest that SCIT may be an effective tool to improve attributional biases and functional outcomes in recent-onset schizophrenia outpatients. Future controlled trials with larger sample size and follow-up assessments should be developed to further understand effective intervention outcomes for this population.

The relationship between alexithymia, hostile attribution bias, and aggression

Prior studies found a positive association between alexithymia and aggression. This study extended existing findings by adopting a subdimensional approach to investigate the unique association of alexithymia factors with reactive and proactive aggression, such as difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT). This study also explored factors associated with the link between alexithymia and aggression by investigating the potential moderating role of hostile attribution bias (HAB). Four hundred and eighty-five college students (275 females) were recruited. Results showed that alexithymia was positively associated with aggression; however, different alexithymia factors did not show equally strong associations with aggression subtypes. Specifically, DIF (in contrast to DDF and EOT) was the strongest correlate of reactive aggression, while EOT (in contrast to DIF and DDF) was the strongest correlate of proactive aggression. Meanwhile, HAB was a moderator for the relationship between alexithymia and aggression, but not between alexithymia factors and aggression subtypes. Implications and limitations of the present study are discussed.

The Influence of Mistreatment by Patients on Job Satisfaction and Turnover Intention among Chinese Nurses: A Three-Wave Survey.

The affective event of mistreatment in the workplace has been recognized as an important factor influencing employee affect and behavior. However, few studies have logically explained and empirically clarified the link between mistreatment by patients and nurses’ job satisfaction and turnover intention. The current study aimed to explore the effects of mistreatment by patients on nurses’ job satisfaction and turnover intention through work meaningfulness and emotional dissonance, as well as the moderating role of hostile attribution bias. Using three-wave survey data collect from 657 nurses who worked in three hospitals in China, we found that mistreatment by patients had a negative effect on nurses’ job satisfaction through work meaningfulness, mistreatment by patients had a positive effect on nurses’ turnover intention through emotional dissonance. Furthermore, nurses’ hostile attribution bias acted as an effective moderator on the relationship. These findings help uncover the mechanisms and conditions in which mistreatment by patients influences nurses’ job satisfaction and turnover intention.

The EUropean Network of National Schizophrenia Networks Studying Gene\u2013Environment Interactions (EU-GEI): Incidence and First-Episode Case\u2013Control Programme

PurposeThe EUropean Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study contains an unparalleled wealth of comprehensive data that allows for testing hypotheses about (1) variations in incidence within and between countries, including by urbanicity and minority ethnic groups; and (2) the role of multiple environmental and genetic risk factors, and their interactions, in the development of psychotic disorders.MethodsBetween 2010 and 2015, we identified 2774 incident cases of psychotic disorders during 12.9 million person-years at risk, across 17 sites in 6 countries (UK, The Netherlands, France, Spain, Italy, and Brazil). Of the 2774 incident cases, 1130 cases were assessed in detail and form the case sample for case–control analyses. Across all sites, 1497 controls were recruited and assessed. We collected data on an extensive range of exposures and outcomes, including demographic, clinical (e.g. premorbid adjustment), social (e.g. childhood and adult adversity, cannabis use, migration, discrimination), cognitive (e.g. IQ, facial affect processing, attributional biases), and biological (DNA via blood sample/cheek swab). We describe the methodology of the study and some descriptive results, including representativeness of the cohort.ConclusionsThis resource constitutes the largest and most extensive incidence and case–control study of psychosis ever conducted.

Mindful social inferences: Decentering decreases hostile attributions

AbstractWhile research indicates that mindfulness can benefit individual well‐being, less is known about its potential impact in the interpersonal domain. In the current research, we examined whether a central element of mindfulness—decentering—decreases hostile attributions in ambiguous social situations. We hypothesized that decentering from experiences—observing and considering them as mental events that arise and disappear—hampers the development of hostile attributions. A series of three laboratory studies, two of which were high‐powered and pre‐registered, demonstrated that decentering decreases hostile attribution in response to ambiguous social scenarios as compared to immersion instructions, and as compared to baseline. Additionally, the results suggest that decentering may be particularly beneficial in reducing hostile attribution bias among participants high in trait rumination. The current findings provide initial insights into the effect of decentering on the development of hostile attribution bias, and the association between mindfulness and interpersonal responses more generally.

Parental influences on child report of relational attribution biases during early childhood

Influences on social cognition, such as hostile attribution biases, are a relatively understudied topic despite the association of hostile attribution biases with important developmental and clinical outcomes. From a developmental perspective, it is particularly important to understand the early development of biases regarding how the intentions of others are perceived, especially in the relationship context. Therefore, understanding potential correlates, such as parental influences, of such biases during early childhood may be especially important. The current study (N = 121) was designed to explore several gaps and limitations in the hostile intent attribution literature, especially the lack of research on hostile attribution biases for relational provocations and associated parent behavior. In particular, this gap was addressed by investigating parental influences on hostile attribution biases for relational provocations during early childhood (i.e., 3–5 years of age) using parent and child reports. It was found that parent hostile attribution biases for relational provocations was significantly associated with child hostile attribution biases for relational provocations. Furthermore, it was demonstrated that parent relational aggression was related to parenting practices. Implications for research and practice are discussed.

Correction to: Is Ultimate Attribution Error Universal? Inter-group Attribution for Success and Failure among University Students in Delhi

In the abstract, the sixth line should read as “Results indicated that both General Caste category and Scheduled Caste category participants showed no inter-group attribution bias.

The role of “Attributions” in social psychology and their relevance in psychosocial health: A narrative review

Assigning motives or reasons to situations and actions have been the basic premise of human existence. Attributing cause to an action makes it logical and easier to comprehend. In social psychology, attribution is the process through which individuals explain the causes of behavior and events. Various theories and models have been proposed to explain this concept, starting from the early works of Fritz Heider in the early 20th century and further advances by Harold Kelley and Bernard Weiner. Attributional concepts can be used in a wide arena of behavioral science ranging from mental health stigma-related interventions to consumerism, corporate and jury psychology, and finally, attributional bias in psychosis and learned helplessness in depression. Attribution theories are viewed as the relevant concepts in the exploration and explanation of a wide repertoire of psychopathologies, especially for culture bound syndromes. Research into the translational use of attributional theories has declined in the recent years, the models being criticized for being mechanistic and reductionistic in approach. Nevertheless, the role of “attributions” in social psychology remains equally important today to explore the various facets of human behavior and reactions. The article explores the relevance of attributions in the fields of psychosocial health. It discusses various theoretical perspectives and frameworks premised on attributional models and narrates the understanding as well as the applications of the relevant theories in the realms of stigma research and consumerism. The criticism and implications in mental health are highlighted thereafter.

Social cognition in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms: A comparative study

Background: Non-affective psychosis refers to psychosis unrelated to mood or affect. Affective psychosis is a psychological disorder where people experience a loss of contact with reality and experience mood disturbances working as a primary cause. The focus has been shifted to the first-degree relatives of these populations to prevent the disorder at the earliest. So, the first-degree relatives are known to be a high-risk population with genetic vulnerability. These two disorders (schizophrenia and mania with psychotic symptoms) show various impairments in various field but these impairments are present to define these disorders, unaffected relatives of these two disorders for different areas like social, cognitive, neurocognitive and social functioning. Cognitive dysfunction and social cognition dysfunction as a trait marker nearly established in affective and non- affective populations. Aims and Objectives: Purpose of this study to assess social cognition, neurocognition and social functioning in FDRs of patients with schizophrenia and mania with psychotic symptoms. Methodology: The sample consisted of 30 FDRs of patients with schizophrenia and mania with psychotic symptoms and 15 normal healthy control. After the initial screening by the clinical assessments, based on their amenability for the interview, Social Cognition Rating Tools in Indian Setting (SOCRATIS) was applied to all three groups. Result and Conclusion: The study found that first degree relatives of patients with schizophrenia group found to be lower in externalized attribution bias on a measure of social cognition compared to FDRs of patients with mania with psychotic symptoms group and healthy controls. And the FDRs of patients with schizophrenia and mania with psychotic symptoms groups were found higher in reaction time in trail making on a measure of neurocognition compared to healthy controls.

A dangerous world implicit theory: examining overlap with other criminogenic constructs

ABSTRACT Ward and Keenan (1999, Child molesters’ implicit theories. Journal of Interpersonal Violence, 14(8), 821–838. doi: 10.1177/088626099014008003) hypothesised that some individuals who sexually offend against children have belief systems through which they perceive the world as an inherently dangerous place – labelled a dangerous world implicit theory (DWIT). Individuals with a DWIT are hypothesised to either (1) believe it is necessary to punish women and/or children who are perceived as threatening, or (2) see children as more accepting than adults, and as capable of understanding and gratifying the individual’s needs and desires. In two online studies (N = 113 and N = 123) we examined the possible overlap between the DWIT and four other constructs: hostile attribution bias, hostile sexism, emotional congruence with children, and a ‘children as sexual beings’ implicit theory. Results suggest that identifying with an individual holding DWIT overlaps considerably with some of the other constructs, but not with hostile attribution bias – a finding that ran counter to our hypotheses.

Systematic Review and Meta-Analysis of Self-Serving Attribution Biases in the Competitive Context of Organized Sport.

This meta-analysis explored the magnitude of self-serving attribution biases for real-world athletic outcomes. A comprehensive literature search identified 69 studies (160 effect sizes; 10,515 athletes) that were eligible for inclusion. Inverse-variance weighted random-effects meta-analysis showed that sport performers have a tendency to attribute personal success to internal factors and personal failure to external factors (k = 40, standardized mean difference [SMD] = 0.62), a tendency to attribute team success to factors within the team and team failure to factors outside the team (k = 23, SMD = 0.63), and a tendency to claim more personal responsibility for team success and less personal responsibility for team failure (k = 4, SMD = 0.28). There was some publication bias and heterogeneity in computed averages. Random effects meta-regression identified sample sex, performance level, and world-region as important moderators of pooled mean effects. These findings provide a foundation for theoretical development of self-serving tendencies in real-world settings.

One-way pendulum?

Purpose Staff shortage in the UK National Health Service has a long history, but is widely predicted to become acute over the next decade. Falling enrolment rates in health professional training and restrictions to migrant labour recruitment have brought the, traditionally neglected, issue of staff retention into sharp relief. The purpose of this paper is to represent the first large scale systematic appraisal of the relative salience of recognised headline drivers of employee exodus from the NHS. Design/methodology/approach The data were collected from an opportunity sample of 1,594 health professionals, managers and administrators employed by the NHS. Participants completed a paired ranking task (Case V method of paired comparisons, Thurston, 1927) to determine the relative importance of eight widely cited reasons for exit. The item set was derived from focus groups conducted as a component of the wider study. Findings Findings revealed almost universal consensus regarding the primacy of shortage of resources, job demands and time pressure. Pay was ranked lower than predicted. Flexible working arrangements do not presented as a key solution, and there is no support for claims of generational differences. Research limitations/implications Survivor population effects could constitute a source of sample bias, i.e. all participants were current NHS employees. It is possible that those who remain may be more resilient or hold different dispositions to leavers. Thus, comparisons by age and grade may not be comparing like with like. Tapping respondent beliefs about the actions of peers can embody some degree of inaccuracy and attribution bias. However, effects can be considered to operate as a source of common, rather than systematic, error across the demographics compared. The medical and dental sample was too small to give confidence in detected differences. Practical implications Findings challenge the claim that wider availability of flexible working hours will significantly reduce exit rates. Pay, being a source of dissatisfaction, does not constitute a key push variable in itself, rather its salience reflects the effort reward-imbalance produced by rises in job demands. Social implications Staff shortages in the NHS represent a threat to: public well-being – waiting lists and demand for care; the well-being of who continue to work in the NHS – job demands and resources; the employment prospects of staff who leave involuntarily, e.g. on grounds of incapacity and threats to health and well-being – extending to impacts on their dependents. Originality/value Issues of staff retention within the NHS are topical and under researched. The findings provide an up to date picture of the relative influence of headline drivers of early exit from the NHS. The study draws upon a more diverse and comprehensive sample of NHS employees that any other known previous studies of early exit. Findings are of potential international relevance to other State health systems. The authors believe this to be the largest (sample) known application of the method of paired comparisons.

Impact of heatwaves and cold spells on the morbidity of respiratory diseases: A case study in Lanzhou, China

More than four hundred million people suffer from respiratory diseases each year. Respiratory diseases are associated with a large disease burden. Heatwaves and cold spells, the two most common extreme weather events, have been shown to have crucial negative effects on the prevalence of respiratory diseases. However, impacts of extreme weather on the prevalence of respiratory diseases has been largely overlooked in western China, where more intense and frequent extreme temperature events have been occurring over the past decades. This research gap will obtain an attribution bias in the effects of extreme weather events on the prevalence of respiratory diseases. Therefore, in this study, we analyzed the impact of heatwaves and cold spells on the morbidity of respiratory diseases using a distributed lag nonlinear model with daily disease cases from 2013 to 2016 in Lanzhou, one of the largest cities in western China. A reverse U-shaped relationship depicted the relationship between temperature and the morbidity of respiratory diseases. The highest relative risk was found at 2.6 °C by 1.15 (95% confidence interval: 1.09–1.21). Furthermore, we found a significant decrease in the relative risk for heatwaves and a significant increase in the relative risk of cold spells when the temperature exceeded the corresponding threshold by 1 °C. Heatwaves and cold spells play harvest effects on the morbidity of respiratory diseases. Our study suggest that the relative risk of respiratory diseases will increase as the climate warms in the future, and thus a preventive system is needed for individuals and medical policy-makers.