Behavior Checklist Research Articles

Demographic background and dangerous behaviors of heroin-addicted patients under maintenance treatment in the North East of Iran (North Khorasan province)

ABSTRACTBackground: In recent years, Iran has experienced an increase in heroin consumption, which endangers the health of individuals as well as the whole society. The present research investigated the demographic indices and dangerous behavior of heroin-addicted patients under maintenance treatment. Methods: This study was conducted as a cross-sectional study in 2015. The sample of this research includes the heroin-addicted patients under treatment in 79 maintenance treatment centers in North Khorasan. The information is gathered by a checklist of dangerous behaviors and demographic indices of the patients. Results: In this study, 842 heroin consumers under maintenance treatment were investigated, 82.4% of whom were male and 17.6% were female. Heroin-addicted patients showed a significant difference in terms of marital status, occupation, addiction initiation, and dangerous behaviors (such as unsafe sexual intercourse, the history of concurrency injection and unsafe sexual intercourse) in two gender groups. Conclusion: It seems that there is a significant difference between male and female heroin-addicts in dangerous behaviors and demographic indices. As such, there is a significant difference between demographic pattern and dangerous behaviors of heroin-addicted patients in Iran and patients from other countries.

Life Skill Training on Behavioural Issues of Adolescents

Adolescence is the most critical phase of an individual. The highly competitive world of today and the absence of traditional norms and support have heightened the stress among adolescents resulting in multiple issues such as depression, anxiety, loneliness, rejection, diffidence, anger, confliction in interpersonal relationship, alcohol abuse and criminal behaviour. An endeavor was made to understand the effect of life skill training on the behavioral issues and skill development of adolescents. Five adolescent students from Kottayam district were selected as sample for the present case study. Life skill training has been given for a period of 9 months. Life skill scale (Vranda, 2007) and Behavioral Checklist (prepared for the present study) were the tools used. The results of the present study laid its emphasis to explore the effectiveness of life skill training on dealing behavioral issues and developing life skill of adolescents.

Ready! Set? Let's Train!: Feasibility of an intensive attention training program and its beneficial effect after childhood traumatic brain injury

BackgroundAttention deficits are common after pediatric Traumatic Brain Injury (TBI); they complicate return to activities of daily living and disrupt socioacademic reintegration. Yet, clinicians in rehabilitation settings have limited access to cognitive remediation protocols for which feasibility has been demonstrated. ObjectiveThe aim of this study was to evaluate the feasibility of intensive attention process training program Ready! Set? Let's Train! (RST), based on an adaptation of the Attention Process Training-I program. Materials and methodsIn a randomized controlled trial, participants with attention deficits were assigned to receive the attention process training intervention (RST) or Homework Assistance (HWA). Pre- and post-intervention assessments consisted of standardized attentional and executive tests and a behavior checklist. ResultsAnalyses conducted for 17 participants (RST, n=8; HWA, n=9; mean age 14.70±2.17 years, 11 males) indicated the study was successful in that it showed improvements in working memory (F(14)=5.44, P=0.04; η2=0.19), inhibition (F(14)=10.18, P=0.007; η2=0.75) and cognitive flexibility (F(14)=5.36, P=0.04; η2=0.57). ConclusionsThese findings indicate positive support for combined process-specific and metacognitive strategy training for attention and executive functions.

Differential profiles of four groups of children referred to an autism diagnostic service in Belgium: Autism-specific hallmarks.

This article aims at exploring distinctive hallmarks of autistic disorders compared to other groups presenting mimicking and/or overlapping conditions. The exploratory study involved 196 children with autism, intellectual disability, language impairment and psycho-affective disorders previously referred to an autism diagnostic service. The autism discriminative tool (ADT), a behavioural checklist, was used to compile and analyse the children's profiles based on the clinical information gathered during diagnostic assessments. All samples were compared and analysed separately according to the checklist's four domains. Children with autism showed greater frequency and severity of impairments on the ADT's social and communication categories. These children also differed from other groups in terms of specific rigid behaviours and high frequency of atypical sensory responses. Results illustrate the psychopathology of autism spectrum disorder suspected children referred to a specialized autism diagnostic service, doing so by providing us with specific clinical profiles.

Confirming the Reliability and Validity of Others' Evaluation Tools Before Adopting for Your Programs

ObjectiveTo confirm the reliability and validity of a previously validated evaluation instrument in a new context. MethodsIn a cross-sectional study, the processes and results of testing Cooking Matters' (CM) use of the Expanded Food and Nutrition Education Program's Behavior Checklist as a retrospective pretest/posttest were described. The researchers determined reliability, face and content validity, and response-shift bias with 95 CM participants. ResultsMost items had acceptable face validity and moderate reliability; other items lacked reliability, or face or content validity (were unrelated to the CM curriculum). Conclusions and ImplicationsProper match between evaluation tools and curricula is needed for appropriate program assessment without which outcome data can be misleading or potentially invalid. Confirmation of validity is essential when adopting others' evaluation tools in new contexts, particularly for programs with widespread use such as federally funded programs and national nonprofit organizations.

A randomised controlled trial on evaluation of the clinical efficacy of massage therapy in a multisensory environment for residents with severe and profound intellectual disabilities: a pilot study.

Recent literature has suggested that relaxation activities can reduce the challenging behaviours of people with intellectual disabilities, particularly in severe and profound grades, due to the counteractive effect of muscle relaxation on emotional frustration or psychological distress. Despite having inconclusive evidence, multisensory environment (MSE) and massage therapy (MT) are the commonly used approaches to relaxation among these people. However, these two approaches have not yet practised or tested in combination for reducing these people's challenging behaviours. A preliminary clinical efficacy trial was conducted to evaluate the effects of MT, MSE and their combined use for residents with intellectual disabilities in a long-term care facility on reducing their challenging behaviours. Eligible residents were recruited and randomly assigned to one of the four study groups (n=11-12 per group), that is, MT in MSE, MSE alone, MT alone or usual care, for a 10-week intervention after a 1-month washout period. Outcome measures, including the Behaviour Problem Inventory, pulse and respiration rates, Behaviour Checklist and Alertness Observation Checklist, were assessed at recruitment and immediately following the interventions. A total of 42 participants (17 men and 25 women) completed the study. There were no significant differences in frequency and severity of challenging behaviours and most of the outcome measures between the four groups at post-test. Nevertheless, there were statistical significant differences on the active and inactive state (Alertness Observation Checklist) between the three treatment and control groups. Many participants in the three treatment groups changed from an active to inactive state (i.e. reduced activity levels) throughout the interventions, especially the MT in MSE. Such inactivity might suggest the participants' brief exhaustion followed by a period of alertness during the treatment activities. But their attention span and social contact to the immediate environment could still be maintained. Participants of MT in multisensory environment acquired more inactive state than the other study groups. This inactive state indicates a state of 'passive alertness', which is more likely in a relaxing manner.

The Effect of Postpartum Depression and Current Mental Health Problems of the Mother on Child Behaviour at Eight Years.

Background Maternal postpartum depression (PPD) could affect children's emotional development, increasing later risk of child psychological problems. The aim of our study was to assess the association between child's emotional and behavioural problems and mother's PPD, considering maternal current mental health problems (CMP). Methods This is a secondary analysis from the EU-Childhood Obesity Project (NCT00338689). Women completed the Edinburgh Postnatal Depression Scale (EPDS) at, 2, 3 and 6months after delivery and the General Health Questionnaire (GHQ-12) to assess CMP once the children reached the age of 8years. EPDS scores > 10 were defined as PPD and GHQ-12 scores > 2 were defined as CMP. The psychological problems of the children at the age of eight were collected by mothers through the Child's Behaviour Checklist (CBCL). Results 473, 474 and 459 mothers filled in GHQ-12 and CBCL tests at 8years and EPDS at 2, 3 and 6months, respectively. Anxiety and depression was significantly increased by maternal EPDS. Children whose mothers had both PPD and CMP exhibited the highest levels of psychological problems, followed by those whose mothers who had only CMP and only PPD. PPD and CMP had a significant effect on child's total psychological problems (p = 0.033, p < 0.001, respectively). Children whose mothers had PPD did not differ from children whose mothers did not have any depression. Conclusions Maternal postpartum depression and current mental health problems, separately and synergistically, increase children's psychological problems at 8years.

Kronos Abuses His Son: A Case Study of Severe Interpersonal Trauma, Dissociation, and Survival in Adolescence

This case study presents case conceptualization, therapeutic intervention, and the subjective and objective therapeutic progress of a 14-year-old adolescent hospitalized with posttraumatic stress disorder (PTSD) following emotional, physical, and sexual abuse by his father. The adaptive information processing (AIP) model that informs eye movement desensitization and reprocessing (EMDR) therapy and the theory of structural dissociation of the personality (TSDP) were used to conceptualize and guide the treatment. Stabilization and orientation to the present were essential to integrate his traumatic memories into a life narrative, and this became a major goal and an outcome of treatment. A single-case AB design was applied in assessing the impact of intervention. The UCLA PTSD Symptom Scale, Strengths and Difficulties Questionnaire—HEL (SDQ-HEL), State-Trait Anxiety Inventory (STAI), and Dissociative Experiences Scale II were administered at 5 different time points to assess changes in the youth’s subjective emotional state and indicated substantial improvement. In addition, objective behavior change (using O’Neill’s Behavior Checklist) was recorded on a daily basis for 7 months and showed a large decrease in the frequency of targeted maladaptive behaviors. The article describes the treatment process which helped the youth to regain a sense of time; establish a coherent sense of self; and maintain adaptive perceptions, emotions, attitudes, and behaviors.

An explorative study on factors associated with sustainable food consumption among students

In order to maintain a liveable world, sustainable food consumption becomes of greater importance as the world population keeps growing and natural resources become depleted. This study aims to explore behaviors and factors associated with sustainable food consumption. The study is based on a qualitative study design, which is given sense to by means of 14 in-depth interviews among students. The questionnaire consisted of open questions focused on factors associated with organic food consumption, questions on background variables and a behavior checklist. Several types of behavior were identified, being the consumption of tap water, limiting waste, freezing food, storing products in optimal conditions, cooking for more people and/or days, and eating less meat. Factors associated with sustainable food consumption as identified in this study are positive and negative beliefs, barriers and abilities, the role of social pressure, emotions, moral considerations, parental consumption, past behavior, values, means, knowledge and perceived urgency. The results of this study indicate that the framework on factors associated with organic food consumption is not comprehensive enough, and needs some expansion in order to be of predictive value for sustainable food consumption as well.

The Observation of Child Behavior During Parent-Child Interaction: The Psychometric Properties of the Crowell Procedure

The observation of child behavior has to be made in ecologically valid contexts. Parent-child interaction was thought to be the most suitable context, since empirical evidence displayed strong associations with children’s behavioral outcomes, psychopathology, social relationships and well-being. Using clinical data from 137 caregiver-child dyads, the main goal of the current study was to test the psychometric properties of an adapted version of the Crowell Procedure among preschoolers. Despite the interest that the Crowell Procedure has aroused, its psychometric properties remain relatively under-documented. This research aimed to study (1) the association between parental and child behavior, (2) the discriminant properties of the Crowell Procedure between preschoolers with a clinical level of externalizing behavior and non-clinical children and (3) the correlation between the Crowell Procedure and a behavioral checklist. The results support the consistency of both tasks and scales, the discriminant properties, external validity and fidelity of the coding system. The Crowell Procedure can therefore be used as an observational paradigm to assess both child and parent behavior in clinical and research contexts. The discriminant analyses revealed that the procedure was effective at differentiating children displaying a clinical level of externalizing behavior from normally developing ones.

The utility of early developmental assessments on understanding later nonverbal IQ in children who are deaf or hard of hearing

ObjectiveIn children who are deaf or hard of hearing (DHH), it is helpful to have meaningful early measures of development in order to provide effective interventions and offer benchmarks that help recognize varied developmental trajectories. The main objective of this study was to compare results of an early developmental assessment prior to 3 years of age to later nonverbal IQ assessed between 3 and 6 years of age in children who are DHH. MethodsThis study included children 3–6 years of age with bilateral permanent hearing who were enrolled in a prospective cohort study on developmental outcomes. As part of the study, children received the Leiter International Performance Scale-Revised, which provided a nonverbal Brief IQ, as well as standardized language assessment and behavioral checklists. Children were included in this analysis if they had received an early developmental assessment with the Gesell Developmental Schedules-Revised as part of a clinical visit with a developmental pediatrician. Correlation coefficients and multiple regression analysis were used to associate the scores on the Gesell (using a developmental quotient) with scores on the Leiter-R Brief IQ. ResultsForty-five participants who enrolled in the observational study had available evaluation results from the Gesell and complete Brief IQ results from the Leiter-R. The adaptive domain of the Gesell had good correlation (r = 0.61, p < 0.0001) with the Brief IQ on the Leiter-R. Children who had stable developmental or intelligence classifications based on scores (<70, 70 to <85, 85 to <100, ≥100) over time were older (>24 months) at the early Gesell assessment. Degree of hearing loss or maternal education did not appear to confound the relationship between the Gesell and the Leiter-R. ConclusionsThe adaptive domain of the Gesell Developmental Schedules – Revised administered in early childhood (under 3 years of age) has good correlation with the nonverbal Brief IQ on the Leiter International Performance Scale-R. Because children who are DHH have a higher likelihood of having a developmental disability compared to the general population, early developmental assessments are often important. Although early developmental assessments have their limitations, our results indicate that they are fairly robust indicators of later development. Such early indicators can be extremely useful in the clinical and educational management of children who are DHH.

Questionnaire-based assessment of executive functioning: Psychometrics

ABSTRACTThe psychometric properties of the Learning, Executive, and Attention Functioning (LEAF) scale were investigated in an outpatient clinical pediatric sample. As a part of clinical testing, the LEAF scale, which broadly measures neuropsychological abilities related to executive functioning and learning, was administered to parents of 118 children and adolescents referred for psychological testing at a pediatric psychology clinic; 85 teachers also completed LEAF scales to assess reliability across different raters and settings. Scores on neuropsychological tests of executive functioning and academic achievement were abstracted from charts. Psychometric analyses of the LEAF scale demonstrated satisfactory internal consistency, parent-teacher inter-rater reliability in the small to large effect size range, and test–retest reliability in the large effect size range, similar to values for other executive functioning checklists. Correlations between corresponding subscales on the LEAF and other behavior checklists were large, while most correlations with neuropsychological tests of executive functioning and achievement were significant but in the small to medium range. Results support the utility of the LEAF as a reliable and valid questionnaire-based assessment of delays and disturbances in executive functioning and learning. Applications and advantages of the LEAF and other questionnaire measures of executive functioning in clinical neuropsychology settings are discussed.

Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors

Introduction: Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians.Method: In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a “brief” and “extended” professionalism checklist for monitoring physician misconduct.Results: This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly.Discussion: Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.

The OutSMARTers Program for Children With ADHD

Objective: This study examined the effects of the OutSMARTers program on social skills, self-regulation, and executive functions compared with a Waitlist group and a parent training program. Method: Participants were 41 children with ADHD, aged 8 to 10 years. All groups were assessed with behavioral checklists and neuropsychological measures at baseline and post-treatment. The two treatment groups were reassessed with behavioral checklists after 3 months. Results: Findings revealed decreased ADHD symptoms, improved social skills, and better emotion regulation at post-treatment for the OutSMARTers compared with the Waitlist group on subjective measures. No differences were found on objective tasks or between the OutSMARTers and Parent groups after treatment but both treatment groups showed some improvement. In addition, most of the post-treatment changes were maintained for both groups 3 months later. Conclusion: The results indicate that the OutSMARTers program seems to benefit children with ADHD, but further research and treatment development is needed.

Investigation of the Impact of QEEG-Based Biofeedback on Attention and Behavioral Features in Young Male Adolescents with ADHD

Introduction: Attention Deficit/Hyperactivity Disorder (ADHD) is a disorder of neurobiological behavioral system. This disorder includes features such as attention deficit, impulsivity, and chronic, disproportionate-with-growth hyperactivity which reduce the child's ability to regulate, control, organize his behavior and cause attention deficit in activity of daily living (ADL). ADHD is one of the most common childhood disorders. The aim of this study was to investigate the effect of QEEG-based biofeedback on behavioral and attention factors of 7 to 14 year-old boys diagnosed with ADHD. Method: 40 boys diagnosed with ADHD were randomly assigned into the experimental and control groups. Integrated Visual and Auditory (IVA) test and Children's Behavioral Check List (CBCL) were used before the treatment and after 8 intervening weeks of treatment in both groups. Moreover, the brain mapping (QEEG) of the experimental group was used to design a treatment protocol. The experimental group received 24 sessions of neurofeedback therapy three times a week. The acquired data was analyzed using the Analysis of Covariance (ACNOVA). Results: Our findings demonstrated a significant difference in test results between the experimental and control groups upon IVA and CBCL tests following the neurofeedback intervention. Moreover, there was a significant difference between pre- and post-tests in the neurofeedback group. Interaction effect was insignificant at the time. Conclusion: Results of the present study showed that neurofeedback can bring significant improvements in attention factors especially, sustained attention and children's externalizing behaviors. As such, neurofeedback may be considered as one of the therapeutic modalities used along with core therapies and medication, though, more research is needed to compare the clinical effects of different treatment protocols with one another.

Obesity Associations with Behavior and Anxiety in Lebanese Adolescents

Aim: To evaluate the influence of obesity on physical, social and emotional well-being of a representative sample of Lebanese adolescents. Methods: A self-administered questionnaire and a behavior checklist were distributed to 700 Lebanese adolescents aged 12-18 years. Results: A total of 587 were collected (response rate: 69.57%) of whom 231(47.4%) were male and 256(52.6%) were female. Overall, 10.5% of the adolescents were obese. Activity score, as part of the competence scale, showed that 77 (15.9%) had activity scores below normal. Moreover, borderline scores were shown in 35 (7.1%) participants, whereas obesity is significantly associated with low level of social activities among female adolescents. There was no statistical significant difference among obese, overweight and normal weight participants of both genders concerning the withdrawal and anxiety depression scales. In conclusion, obesity among Lebanese adolescents is significantly associated with decreased social activity level among females and imposes a health concern for both genders in later years. The alarming increase in obesity in the juvenile population today.

Education Considerations: Communication Curricula, Simulated Resuscitation, and Duty Hour Restrictions.

In routine practice, an intensivist must convey intricate and often devastating information to patients and surrogates, guiding them through complex decisions with life-and-death implications. Although the Accreditation Council for Graduate Medical Education (ACGME) and the American Thoracic Society have called for pulmonary and critical care medicine (PCCM) trainees to receive formal communication skills training, few curricula have been developed, implemented, and published. Focusing on the family meeting as a prototypical intensive care unit (ICU) encounter, McCallister and colleagues (1) developed a year-long communication skills educational program. Beginning with a 3-hour didactic workshop incorporating role plays, the program was interwoven into the first year of PCCM fellowship. The authors created a checklist-based assessment derived from available literature on ICU communication, the Family Meeting Behavioral Skills Checklist, to facilitate feedback and monitor evolution of fellows’ skills. This tool was used for self-evaluation, to provide structured feedback from palliative medicine faculty observing fellows conducting family meetings, and by two blinded psychologists who scored digital recordings of simulated family meetings performed before and after the intervention. In a pre–post analysis, trainees demonstrated a significant increase in total observed Family Meeting Behavioral Skills Checklist skills from 51 to 65% (P, 0.01; Cohen’s D effect size, 1.13) and improved self-confidence (from 77 to 89%, P, 0.01; effect size, 0.87). In the same issue of AnnalsATS, Hope and colleagues (2) describe a communication skills program implemented in their medical ICU. This 1-month curriculum incorporated didactic sessions focused on palliative care, ethics, and end-of-life care, as well as several family conference simulations. Key communication concepts were emphasized through repetition and reinforcement. In unblinded pre–post faculty evaluations fellows demonstrated a statistically significant improvement in three skills: setting an agenda (64% vs. 41%; chi-square, 5.27; P = 0.02); summarizing the care the patient would receive (64% vs. 39%; chi-square, 6.21; P = 0.01); and outlining the follow-up plan (60% vs. 37%; chi-square, 5.2; P = 0.02). Both fellowships created a didactic series, an original checklist evaluation, and used both self-assessments and simulations to judge trainees’ progress. Whereas one was interwoven throughout the year, the other occurred in a single medical ICU rotation. These studies demonstrate the feasibility of embedding communication training in PCCM fellowship, thereby improving trainees’ observable skills and self-confidence. Further study is required to validate these novel assessment tools and measure impact of the educational interventions on patient-centered outcomes, including attention to emotion and to assess optimal structure and duration of curriculum. n

Effect of an Educational-Supportive Program Based on Roy Adaptation Model on Marital Satisfaction in Mastectomy Patients Receiving Chemotherapy

Background: Regarding nurses' significant role in improving quality of marital life in mastectomy patients and their families, implication of the adaptation model can help nurses reaching this goal. Aim: This study aimed to determine Effect of an educational-supportive program based on Roy This quasi-experimental study was performed on 69 mastectomy patients receiving chemotherapy in 2013 in clinical services in Tehran, Iran. The samples were randomly allocated to two groups. The data collection instrument was ENRICH Marital Satisfaction scale (2011). In the experimental group, maladaptive behaviors and their stimuli were determined by the questionnaire, and then adaptive strategies were implemented in 45 days. The program was based on support (patients instruction), peer group, weblog, meeting with the participants’ spouses, and three-month follow-up using behaviors checklist. Control group patients received the regular treatment sessions. T-test, Pearson’s correlation coefficient, Spearman's rank correlation coefficient, and Chi-square tests were run, using SPSS version 19. Results: In experimental group, paired sample t-test reflected an increase in marital satisfaction from 24.7±2.6 before to 32.9±3.5 after the intervention (P=0.03). However, no significant differences were observed in the control group from 26/7±4/6 before to 26/5±4/8 after the intervention in this regard (P=0/63). Implications for Practice: Roy Adaptation Model can be used as a framework for designing educational-supportive programs to improve quality of marital life in mastectomy patients receiving chemotherapy.

PELATIH KETRAMPILAN MANAJEMEN MARAH UNTUK AGRESI VERBAL ORANG DEWASA DENGAN GANGGUAN PSIKOTIK SINGKAT

The purpose of this study is to test the effectiveness of anger management skill training to reduce verbal aggression level. With a single case design, a 24 years man who had a brief psychotic disorder participated this study. Data were collected by interview, observation, and behavior checklist. Anger management skill training was delivered in six sessions. Data analysis showed that the verbal aggression frequency of the patient decrease, from five times to once a day. Â Key words : anger management skill training, verbal agression , brief psychotic disorder

Self-Efficacy and Sleep Quality as Mediators of Perceived Stress and Memory and Behavior Problems in the link to Dementia Caregivers’ Depression in Taiwan

ABSTRACTObjectives: Caregivers’ perceived stress and reactions to patients’ memory and behavior problems have been commonly regarded as outcomes in caregiving research; however, these variables may also serve as predictors of caregivers’ depressive symptoms. The current study investigated the relationship between perceived stress and reactions to patients’ problems and depression among the family caregivers of persons with Alzheimer’s disease. Additionally, we examined caregiving self-efficacy and sleep quality as possible mediators in the relationship between perceived stress and reactions to patients’ memory and problem behaviors and depression.Methods: This study is a cross-sectional study. The study sample consisted of 72 family members caring for a loved one with Alzheimer’s disease who completed a set of questionnaires that included the Perceived Stress Scale, the Chinese Pittsburg Sleep Quality Index, the Revised Scale for Caregiving Self-efficacy, and the Revised Memory and Behavior Checklist (RMBPC).Results: The results indicated that both higher perceived stress and RMBPC reaction scores were directly and indirectly associated with higher depressive symptoms. A specific domain of caregivers’ self-efficacy and sleep quality mediated the indirect path.Conclusion: These findings suggest that caregiving self-efficacy and sleep quality may function as mechanisms through which perceived stress and reactions influence depressive symptoms and that this mechanism may be domain specific.