Bias-corrected Bootstrap Confidence Intervals Research Articles

Inhibitory control and negative affect in relation to food intake among youth

Negative affect and poor inhibitory control are related to disinhibited eating behaviors in youth and may contribute to the development and/or maintenance of obesity. Although few studies have jointly examined these constructs in youth, it has been theorized that poor inhibitory control may be driven by negative affect. If supported, impaired inhibitory control, driven by negative affect, could represent a modifiable neurocognitive treatment target for disinhibited eating. The current study examined whether inhibitory control mediates the relationship between negative affect and eating among youth. Youth (8–17 years) participated in a Food Go/No-Go neurocognitive task to measure inhibitory control as the percentage of commission errors. A composite negative affect score was created from self-report measures of anxiety and depression. A laboratory buffet meal modeled to simulate disinhibited eating was used to measure total and snack food intake. Cross-sectional mediation models with bias-corrected bootstrap confidence intervals (CI) were conducted using negative affect as the independent variable, inhibitory control as the mediator, and intake patterns as dependent variables. One-hundred-eighty-one youths (13.2 ± 2.7y; 55% female; BMIz 0.6 ± 1.0) were studied. Total Go/No-Go commission errors mediated the relationship between negative affect and total intake (95%CI = [0.3, 31.6]), but not snack intake (95%CI = [-2.5, 7.3]). Commission errors for Food-Go blocks significantly mediated the relationship between negative affect and total intake (95%CI = [7.7, 44.4]), but not snack intake (95%CI = [-3.4, 9.5]). Commission errors on Neutral-Go blocks did not significantly mediate any of these relationships. Negative affect may lead to poorer inhibitory control as well as a stronger approach tendency toward food, increasing the likelihood of engaging in disinhibited eating. Future research should determine if, in combination with approaches to reduce negative affect, improved inhibitory control could help prevent overeating in youths with depressive or anxiety symptoms.

Mediating Effects of Parental Stress on Harsh Parenting and Parent-Child Relationship during Coronavirus (COVID-19) Pandemic in Singapore.

Because of the Coronavirus (COVID-19) pandemic, “Circuit-breaker” safety distancing was implemented in Singapore from April to May 2020. Schools and workplaces were closed and parents had to balance telecommuting with parenting responsibilities. Coupled with the high degree of economic uncertainty and reduced social support, these circumstances are hypothesized to increase parenting stress. Based on the Parental Stress Model, this study aims to understand how parents’ perceived impact of COVID-19 increased harsh parenting and reduced parent-child relationship closeness through the mediating effects of parenting stress. We collected data from 258 parents living in Singapore using online surveys disseminated through Facebook and community organizations. Our predictor was the perceived impact of COVID-19. Parental stress (mediator) was measured with the Parental Stress Scale. Two outcomes were used: parent-child relationship closeness and harsh parenting (spanking, yelling). Using mediation analysis in the SEM framework, we tested the indirect effects using bias-corrected bootstrap confidence intervals. Our results indicated that parenting stress was a significant mediator in the relationship between the perceived impact of COVID-19 and (a) parent-child closeness (indirect effect = −.30, Bootstrap 99% CI[−.59, −.11]) and (b) harsh parenting (indirect effect = .58, Bootstrap 99% CI[.25, .94]). The impact of COVID-19 and stay-home orders can increase parenting stress. This, in turn, has a negative impact on parenting by affecting parents’ relationship with their children and increasing the use of harsh parenting. Given that these are risk factors for potential child abuse, supporting parents and mitigating the impact of COVID-19 are important.

Mindfulness and Empathy: Mediating Factors and Gender Differences in a Spanish Sample.

Numerous research studies link mindfulness training to improved empathy. However, few studies focus on the mediating factors of empathy. This work has three objectives: (a) to analyze the possible mediation of mindfulness as a feature in this relation, (b) to analyze the mindfulness factors that mediate in the increase of empathy and (c) to analyze the moderating role of gender. The sample was composed of 246 Spanish-speaking university students (M = 24.08 years, SD = 8.43). The instruments used were the Five Facet Mindfulness Questionnaire (FFMQ) and the Toronto Empathy Questionnaire (TEQ). For data analysis, the indirect effect was calculated using 10000 bootstrap samples for the bias-corrected bootstrap confidence intervals (BCI). The improvement of empathy is mediated by the changes in mindfulness trait (B = 0.233, p < 0.001), disappearing in the presence of this mediator, the direct effect of mindfulness practice on empathy (B = 0.161, p = 0.394). We did not find a differential functioning of this mediation according to gender. Observing and describing are the FFMQ factors that mediate significantly between mindfulness practice and empathy.

Abstract P212: Depressive Symptoms Mediate the Relationship Between Dispositional Mindfulness and Diet Quality Among Healthy Midlife Adults

Background: Emerging evidence suggests that mindfulness, a practice of non-judgmental awareness of present experience, may reduce eating psychopathology and emotion-driven eating. However, few studies have explored the relationship between dispositional mindfulness and diet quality or sought to identify factors that mediate the effect of dispositional mindfulness on diet quality. Methods: Community-dwelling midlife participants ( N = 406; M age = 43.19, SD = 7.26; M BMI = 27.08, SD = 5.28; 52% female) reported dispositional mindfulness using the Mindful Attention Awareness Scale, depressive symptoms using the Center for Epidemiological Studies Depression Scale, and perceived stress using the Perceived Stress Scale. Dietary intake was assessed using the Block Food Frequency Questionnaire, from which the 2015 Healthy Eating Index (HEI) was derived. Direct and mediating effects of dispositional mindfulness, depressive symptoms, and perceived stress on overall HEI scores were analyzed using the mediation package in R with bias-corrected bootstrapped confidence intervals (BootCI). Age, sex, education and BMI were entered as covariates in all models. Results: Higher dispositional mindfulness was associated with higher diet quality ( β = 0.095, p = 0.04). Depressive symptoms significantly mediated the relationship between dispositional mindfulness and overall diet quality (average causal mediation effect [ACME] = 0.6962, BootCI = 0.104-1.42, p = 0.03) such that higher mindfulness was associated with higher overall diet quality through lower depressive symptoms. Perceived stress was significantly negatively correlated with dispositional mindfulness ( β = -0.310, p &lt;0.01) but was not related to diet quality ( β = -0.039, p = 0.44) and therefore did not mediate the relationship between mindfulness and diet quality (ACME = 0.173, BootCI = -0.261-0.65, p = 0.46). Conclusions: These cross-sectional data provide initial evidence that dispositional mindfulness may relate to diet quality among midlife adults, an effect that may be explained in part by lesser depressive symptomatology. Given that lifestyle behaviors in midlife are leading determinants of risk for cardiovascular and neurocognitive disease in late life, interventions targeted at enhancing mindfulness in midlife may plausibly mitigate disease risk. Additional research assessing the impact of mindfulness interventions on diet quality are warranted.

Relationship of Workplace Violence to Turnover Intention in Hospital Nurses: Resilience as a Mediator

This study aimed to identify the relationship between workplace violence and turnover intention, and the mediation effect of resilience on the relationship in hospital nurses. This was a cross-sectional study. A total of 237 registered nurses were recruited from three hospitals in South Korea from April to May 2019. Participants were invited to complete self-reported questionnaires that measure workplace violence, turnover intention, resilience, and demographic information. The data obtained were analyzed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval (5,000 bootstrap resampling). After controlling demographic covariates, workplace violence significantly accounted for the variance of turnover intention. It was also demonstrated that resilience partially mediated the relationship between workplace violence and turnover intention in hospital nurses. A 73.8% of nurses had experienced workplace violence (such as attack on personality, attack on professional status, isolation from work, or direct attack). Workplace violence directly influences turnover intention of nurses and indirectly influences it through resilience. Therefore, hospital administrators need to develop and provide a workplace violence preventive program and resilience enhancement program to decrease nurses' turnover intention, and leaving.

Exact Inference of a Simple Step-Stress Model with Hybrid Type-II Stress Changing Time

In this article, we consider a simple step-stress model for exponentially distributed lifetime units. As failure rate is lower at the initial stress level, therefore, it is important to pay more attention to the stress changing time. Here, we consider a simple step-stress model where the stress level changes either after a prefixed time or after a prefixed number of failures, whichever occurs later. It ensures a prefixed minimum number of failures at the first stress level and also sets up a control on the expected experimental time. We have obtained the maximum likelihood estimators of the model parameters along with their exact distributions. The monotonicity properties of the maximum likelihood estimators have been established here, and it can be used to construct the exact confidence intervals of the unknown parameters. We provide approximate and bias-corrected accelerated bootstrap confidence intervals of the model parameters. We also define an optimality criteria and based on that obtain an optimal stress changing time for a given sample size. Finally, an extensive simulation study has been performed to asses the performance of the proposed methods and provide the analyses of two data sets for illustrative purpose.

SOCIODEMOGRAPHIC DISADVANTAGE, LIVING WITH A SMOKER, AND OBESITY IN MIDDLE-AGED AND OLDER WOMEN

Although sociodemographic disadvantage is a recognized risk factor for obesity, the potential role of living with a smoker in this relationship has been unexamined. This study investigated: (a) the association between sociodemographic disadvantage and living with a smoker, and (b) the role of living with a smoker in partially explaining the link between sociodemographic disadvantage and obesity. The study used limited access data from the Women’s Health Initiative Observational Study obtained from NHLBI. Participants were 91,888 women ranging in age from 50 to 79; 6,527 participants reported living with a smoker. Analyses were cross-sectional. Logistic regression analyses examined paths in the proposed model; bias-corrected bootstrapped confidence intervals tested indirect effects. All analyses controlled for age, marital status, and participants’ current smoking status. Results demonstrated a significant association (p < .001) between sociodemographic disadvantage and living with a smoker across three measures of disadvantage (for low education, low income, and Black ethnicity, ORs were 1.95, 2.10, and 2.63, respectively), as well as between living with and smoker and obesity (OR = 1.71). Moreover, the unstandardized indirect effect (CIs are in brackets) from sociodemographic disadvantage to obesity through living with a smoker was statistically significant for all three measures of disadvantage (for low education, low income, and Black ethnicity, indirect effects = .05 [.04, .06], .06 [.05, .06], and .07 [.06, .08], respectively). These findings underscore the need for innovative household-level interventions for disadvantaged families living with a smoker integrating smoking- and obesity-prevention efforts. This project was supported by the NIH/NCI (R03CA215947).

Parenting stress mediates the association between cyanotic congenital heart disease and internalising problems in children and adolescents.

Children and adolescents with cyanotic congenital heart disease have been found to be at an increased risk of internalising problems. The underlying mechanisms, however, remain uncertain. To examine the association between cyanotic congenital heart disease and internalising problems and assess whether parenting stress mediates this association. The study sample was 699 children and adolescents (aged 2-17 years) with congenital heart disease (253 with cyanotic congenital heart disease and 446 with acyanotic congenital heart disease) in Taiwan. The Child Behavior Checklist and the Parenting Stress Index were used to assess internalising problems and parenting stress, respectively. A series of multiple regression models was conducted using the SPSS PROCESS procedure to test the association between types of congenital heart disease and internalising problems and the mediating role of parenting stress. A bootstrapping approach was applied to determine the significance of mediation. Compared with acyanotic congenital heart disease, cyanotic congenital heart disease was associated with increased levels of internalising problems (B=2.52, P<0.01), and this association was mediated by parenting stress (B=0.97, 95% bias-corrected bootstrap confidence interval 0.24, 1.75). In particular, parents of children with cyanotic congenital heart disease reported significantly more parenting stress compared with parents of children with acyanotic congenital heart disease (B=4.63, P<0.01), which contributed to elevated levels of internalising problems in the offspring (B=0.21, P<0.001). Cyanotic congenital heart disease conferred risks for internalising problems in children and adolescents, and this association was mediated by parenting stress. Interventions to decrease internalising problems in children and adolescents with cyanotic congenital heart disease may be more effective by targeting parenting stress.

Testing a Moderated Mediation Model of MBCT’s Effects for Psoriasis Patients

The evidence base supporting the positive impact of mindfulness-based programs (MBPs) has increased over the last decade. Methodological limitations in this literature, however, limit the extent to which it can be said that compelling evidence of MBP efficacy exists. The mechanisms by which MBPs effect change are also unclear. This study attempts to identify these mechanisms. This study used data from an RCT (N = 101) investigating the impact of a mindfulness-based cognitive therapy (MBCT) program on self-reported psoriasis, depression, anxiety, and psychological wellbeing. We tested moderated mediation effects of changes in attention regulation, self-compassion, acceptance, mindfulness, non-attachment, aversion, rumination and worry scores post intervention on anxiety, depression, and psychological wellbeing. Total, direct and indirect effects were estimated by bootstrapped moderated mediation analyses providing 95% bias-corrected bootstrap confidence intervals. The results indicated that changes in self-compassion were associated with changes in anxiety and attention regulation with psychological wellbeing when moderated by group allocation post intervention. Decreases in aversion were also found to be significantly associated with improved psychological wellbeing when mediated by reduced rumination, and reduced anxiety when mediated by decreases in worry. Increased mindfulness was found to be significantly associated with reduced anxiety when mediated by reduced worry. This study provides some initial evidence on what the mechanisms of mindfulness might be.

Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden

BackgroundThe aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender.MethodsData from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011˗2013 was analyzed within a Structural Equation Modeling (SEM) framework.ResultsOur results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = ˗0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83˗3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = ˗0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06˗1.26). Gender did not moderate this pattern.ConclusionThe results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.

Problem-Based Learning Could Tackle the Issue of Insufficient Education and Adherence in People Living With HIV/AIDS.

Background: Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence. Methods: In this retrospective cohort study, we assessed the effect of problem-based learning (PBL) approaches to HIV-related education and adherence outcomes among PLWHA and a college student sample. In our study, compared with 309 demography-matched control participants using conventional counseling methods (109 PLWHA and 200 college students), 321 subjects (111 PLWHA and 210 college students) chose to learn HIV-related knowledge via PBL-integrated methods. Co-primary outcomes were self-administered questionnaire after HIV-related education by all participants and self-reported medication adherence by newly diagnosed PLWHA, measured in terms of the number of missed doses in the past week at each of the seven visits during a 1-year period. Multivariate regression models adjusting different covariates were used to test the robustness of HIV awareness and adherence association. Mediation model was used to investigate the relationship among PBL training, awareness of HIV, and ART adherence. Results: The knowledge scores of participants in the PBL group were higher than those in the controls (P = 0.001), especially the subgroup of newly diagnosed PLWHA in the PBL group (P = 0.001). The HIV-related health scores of the PBL college students were also higher than those of subjects exposed to conventional education (P < 0.001). There was no significant difference between the two by newly diagnosed PLWHA groups in the number of missed doses during the past week at each visit except at the first follow-up visit (P = 0.018). The indirect effect of PBL-integrated education on ART adherence at the 2-week visit through HIV awareness had a point estimate of 0.0349 and a 95% bias-corrected bootstrap confidence interval of 0.0061∼0.0874 in newly diagnosed PLWHA. Conclusions: PLWHA and college students using PBL showed improved awareness of HIV and higher levels of recent ART adherence; however, there was no change in long-term ART adherence in newly diagnosed PLWHA.

Insomnia symptoms, cannabis protective behavioral strategies, and hazardous cannabis use among U.S. college students.

Previous research has reported that sleep problems longitudinally predict both onset of cannabis use and cannabis-related problems. However, the mediators of this relationship remain unclear. The present study examined (a) the concurrent relationship between insomnia symptoms and hazardous cannabis use and (b) examined whether use of protective behavioral strategies (PBS) for cannabis mediated this relationship among college student cannabis users. Participants were 984 (69.9% female) college students who reported consuming cannabis at least once in the past month and completed measures of insomnia, cannabis PBS, and cannabis misuse. Data were analyzed by structural equation modeling for binary and count outcomes. The significance of the mediator was evaluated using bias-corrected bootstrap confidence intervals. Insomnia symptoms were associated with an increase in the odds of hazardous cannabis use and possible cannabis use disorder. Cannabis PBS significantly mediated the relationship between insomnia symptoms and hazardous cannabis use, cannabis use disorder symptoms, and cannabis-related problems. Specifically, higher reports of insomnia symptoms were associated with lower use of cannabis PBS; which in turn was associated with an increase in the odds of hazardous cannabis use and possible cannabis use disorder, as well as a higher report of cannabis-related problems. Implications of these findings on the prevention of cannabis use problems among college students in the United States were discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluation of Bootstrap Confidence Intervals Using a New Non-Normal Process Capability Index

This paper assesses the bootstrap confidence intervals of a newly proposed process capability index (PCI) for Weibull distribution, using the logarithm of the analyzed data. These methods can be applied when the quality of interest has non-symmetrical distribution. Bootstrap confidence intervals, which consist of standard bootstrap (SB), percentile bootstrap (PB), and bias-corrected percentile bootstrap (BCPB) confidence interval are constructed for the proposed method. A Monte Carlo simulation study is used to determine the efficiency of newly proposed index Cpkw over the existing method by addressing the coverage probabilities and average widths. The outcome shows that the BCPB confidence interval is recommended. The methodology of the proposed index has been explained by using the real data of breaking stress of carbon fibers.

Mediation Effect of Resilience on The Relationship Between Self-Efficacy and Competitiveness Among University Students

This study aims to evaluate the mediation role of resilience on the link between self-efficacy and competitiveness among university students in Malaysia. One hundred and thirty-six participants from several universities in Malaysia were recruited to respond to an online form consisted of the following scales: adapted versions of brief resilience scale from Smith et al, self-efficacy scale from Biemann, Kearney and Marggraf, and Personal Development Competitive Attitude Scale from Ryckman, Hammer, Kaczor and Gold. Data was analyzed by using SPSS with PROCESS Macro and full mediation has been observed. Bias-corrected bootstrap confidence interval test indicated that the indirect effect of self-efficacy on competitiveness was significant and the Sobel test had confirmed the significance of the mediation. Further discussion, limitation and suggestion are discussed in the end of the paper.

Associations between residential treatment length, PTSD, and outpatient healthcare utilization among veterans.

Premature discontinuation of posttraumatic stress disorder (PTSD) treatment is generally associated with poorer outcomes for veterans with PTSD. What is less clear is whether treatment benefits, as a function of treatment length, persist, as well as predict less future mental health care utilization. We sought to determine whether length of stay (LOS) in residential PTSD treatment predicted discharge PTSD symptom severity and outpatient mental health care utilization. We hypothesized discharge PTSD Checklist (PCL) scores would mediate the relations between LOS in residential treatment and outpatient mental health care utilization. The current study included 740 veterans who received residential PTSD treatment within 5 VA hospitals and completed intake and discharge assessments, including the PTSD Checklist (PCL). Information about LOS in residential treatment and outpatient mental health care utilization was obtained from the National Patient Care Database. We examined the relations between residential LOS, discharge Posttraumatic Stress Disorder Checklist (PCL), and outpatient mental health care utilization. Nonparametric bootstrapping was utilized to test for the significance of the indirect effect. Veterans who stayed in residential treatment longer had lower PCL scores at discharge (est. = -2.50, SE = .51, p < .001), and veterans with lower PCL scores at discharge sought fewer outpatient mental health visits (est. = .31, SE = .14, p = .03). A bias-corrected bootstrap confidence interval for the indirect effect (ab = -.77) based on 10,000 bootstrap samples was entirely below zero (-1.72 to -.05). This indicates discharge PCL mediated the relations between LOS and outpatient mental health care utilization, such that individuals with a longer LOS in residential PTSD treatment had lower PCL scores at discharge and thus utilized less outpatient mental health care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Rumination Mediates and Moderates the Relationship between Bullying Victimization and Depressive Symptoms in Chinese Early Adolescents

Being bullied has been recognized as a risk factor for depression in youth. However, our knowledge about the mechanisms by which bullying victimization is linked with depression remains limited. The present study examined whether rumination, a negative thought process, would mediate or moderate this link. We further simultaneously investigated two types of bullying victimization as the predictors of depression, namely traditional bullying victimization and cyberbullying victimization. A convenience sample of 512 Chinese early adolescents (43.4% girls; Mage = 12.67) participated in this survey. They completed a paper-pencil questionnaire measuring their traditional bullying victimization, cyberbullying victimization, rumination, and depressive symptoms. Bias-corrected bootstrap confidence intervals were used to test for the mediation effects. Results indicated that rumination mediated and moderated the relationships between traditional bullying/cyberbullying victimization and depressive symptoms. Both types of bullying victimization were positively associated with rumination, which in turn was positively associated with depressive symptoms. In addition, the positive relations between two types of bullying victimization and depressive symptoms were significant only among adolescents with high levels of rumination. The present findings extend our knowledge of how rumination functions in the stressor-depression relationship. The preventive and therapeutic efforts on depression in adolescents should directly focus on decreasing their engagement in rumination.

An examination of the associations between pediatric loss of control eating, anxiety, and body composition in children and adolescents

BackgroundData on the link between anxiety and body composition in youth are mixed. Yet, anxiety and disordered eating are highly correlated. One pathway between anxiety and excess body weight and fat mass may be through loss of control (LOC) eating. We examined whether LOC eating mediated the relationship between anxiety and body composition in youth with and without overweight. MethodNon-treatment-seeking youth (8–17 years) participated in studies examining weight and eating behaviors. Anxiety (child- and parent-report of child) and LOC eating were assessed by self-report questionnaires and interviews, respectively. Fat mass was assessed by dual-energy x-ray absorptiometry or air displacement plethysmography. Cross-sectional mediation models with bias-corrected bootstrap confidence intervals (CI) were conducted. Results257 youth (12.91 ± 2.76 years; 52.5% female; BMI-z 0.93 ± 1.07) were studied. There was a significant indirect path between child-reported anxiety and both BMI-z (ab = .005, SE = 0.003, 95% CI = 0.001–0.01) and body fat mass (ab = 0.001, SE = 0.001, 95% CI ≤0.001–0.003) through the number of LOC episodes in the past month. No significant indirect paths through the number of LOC episodes was observed for parent-report of child anxiety on BMI-z (ab = 0.004, SE = 0.01, 95% CI = −0.01–0.03) or body fat mass (ab = 0.001, SE = 0.002, 95% CI = −0.002–0.01). No direct paths were observed between anxiety and body composition regardless of the informant. DiscussionLOC eating appears to mediate the relationship of child-reported anxiety with body composition in non-treatment seeking boys and girls. Prospective data are needed to determine if anxiety promotes LOC eating that results in increased risk for excess body weight and fat gain.

Perceived epilepsy stigma mediates relationships between personality and social well-being in a diverse epilepsy population

IntroductionPerceived epilepsy stigma and reduced social well-being are prevalent sources of distress in people with epilepsy (PWE). Yet, research on patient-level correlates of these difficulties is lacking, especially among underserved groups. Materials and methodsRacially/ethnically diverse adults with intractable seizures (N=60, 62% female; 79% Black, 20% Hispanic/Latino, 8% White) completed validated measures of personality (NEO Five Factor Inventory, NEO-FFI-3), perceived epilepsy stigma (Epilepsy Stigma Scale, ESS), and quality of life (Quality of Life Inventory in Epilepsy, QOLIE-89). Controlling for covariates, ordinary least-squares (OLS) regression evaluated the total, direct, and indirect effects of NEO-FFI-3 neuroticism and extraversion scores on epilepsy-related social well-being (i.e., combination of QOLIE-89 social isolation and work/driving/social function subscales, α=0.87), mediated through perceived stigma. ResultsIn separate models, higher levels of neuroticism (N) and lower levels of extraversion (E) were significantly and independently associated with greater perceived stigma (N path a=0.71, p=0.005; E path a=−1.10, p<0.005). Stigma, in turn, was significantly and independently associated with poorer social well-being (N path b=0.23, p<0.001; E path b=−0.23, p<0.001). Bias-corrected bootstrap confidence intervals (CIs) showed that neuroticism and extraversion were indirectly associated with social well-being through their respective associations with perceived stigma (N path ab=−0.16, 95% CIs [−0.347, −0.044]; E path ab=0.25, 95% CIs [0.076, 0.493]). ConclusionHigher neuroticism and lower extraversion covaried with stigma beliefs, and these may be markers of poor social outcomes in PWE. Mediation models suggest that targeting epilepsy stigma beliefs may be a particularly useful component to incorporate when developing interventions aimed at promoting social well-being in diverse PWE.

Associations of mindful eating domains with depressive symptoms and depression in three European countries

ObjectiveTo examine associations of mindful eating domains with depressive symptoms and depression in three European countries. Moderation by change in appetite—with increased appetite as marker for depression with atypical features — was also tested. MethodsData were collected in Denmark (n = 1522), Spain (n = 1512) and the Netherlands (n = 1439). Multiple linear and logistic regression analyses segregated by country were used to test associations of four mindful eating domains (Mindful Eating Behaviour Scale; MEBS) with depressive symptoms (continuous score on the Center for Epidemiologic Studies Depression Scale; CES-D) and depression (score above the CES-D cut-off value, and/or use of antidepressants, and/or psychological treatment). Moderation by change in appetite was tested with bias-corrected bootstrap confidence intervals. ResultsThe domains Focused Eating, Eating with Awareness and Eating without Distraction were significantly negatively associated with depressive symptoms and depression in all three countries (e.g. Focused Eating Denmark: B = − 0.71, 95% CI: − 0.87, − 0.54; OR = 0.89, 95% CI: 0.86, 0.93). The domain Hunger and Satiety Cues (only measured in the Netherlands) was significantly positively associated with depressive symptoms in the adjusted models (B = 0.09, 95% CI: 0.02, 0.16), but not with depression (OR = 1.02, 95% CI: 0.98, 1.05). These associations were found for both people with and without increased appetite. LimitationsThe cross-sectional design, which makes it impossible to draw causal conclusions. ConclusionsThe present study indicates that higher scores on three mindful eating domains are consistently associated with a lower level of depressive symptoms and a lower likelihood of having depression in three European countries.

Mediators of Treatment Effect in the Back In Action Trial: Using Latent Growth Modeling to Take Change Over Time Into Account.

Objectives:To test whether change in fear-avoidance beliefs was a mediator of the effect of treatment on disability outcome, and to test an analytical approach, latent growth modeling, not often applied to mediation analysis.Methods:Secondary analysis was carried out on a randomized controlled trial designed to compare an intervention addressing fear-avoidance beliefs (n=119) with treatment as usual (n=121) for patients with low back pain, which found the intervention to be effective. Latent growth modelling was used to perform a mediation analysis on the trial data to assess the role of change in fear-avoidance beliefs on disability outcome. The product of coefficients with bias-corrected bootstrapped confidence intervals was used to calculate the mediating effect.Results:A statistically significant mediating effect of fear-avoidance beliefs on the effect of treatment on disability outcome was found (standardized indirect effect −0.35; bias-corrected 95% CI, −0.47 to −0.24). Poor fit of the model to the data suggested that other factors not accounted for in this model are likely to be part of the same mediating pathway.Discussion:Fear-avoidance beliefs were found to mediate the effect of treatment on disability outcome. Measurement of all potential mediator variables in future studies would help to more strongly identify which factors explain observed treatment effects. Latent growth modelling was found to be a useful technique to apply to studies of treatment mediation, suggesting that future studies could use this approach.